title: Seamless reconstruction of mitral leaflet and chordae with one piece of pericardium.
abstract: OBJECTIVE
  Mitral valve repair is challenging when enough pliable mitral leaflets and chordae are not left intact because of extensive infective endocarditis or chronic sclerotic degeneration. For those cases, we developed a simple method to reconstruct defective leaflets and chordae en bloc with a piece of pericardium, and the mid-term results were evaluated.
  
  
  METHODS
  From January 2009 to November 2013, 25 patients with the mean age of 63 (range 20-88) years underwent this operation. The causes of mitral regurgitation were infective endocarditis in 8, sclerotic degeneration in 8, leaflet dehiscence of previous repair in 2, mitral annular calcification in 3, rheumatic in 2 and congenital in 2. After complete debridement of infected or consolidated tissue, we reconstructed defective mitral leaflets and chordae en bloc with a piece of glutaraldehyde-treated autologous pericardium. To substitute posterior leaflet and chordae, the pericardium was trimmed into a narrow pentagonal shape. The pointed end was attached directly to the corresponding papillary muscle, basal side edges to remnant leaflets on both sides, and the base to the annulus. For anterior leaflet, the pericardium was trimmed into a triangular shape if the lesion was confined in the left or right half or into a double-triangle shape if the lesion involved whole anterior leaflet. The summit of triangle was fixed to corresponding papillary muscle, and the base to remnant anterior leaflet, thus reconstructing coaptation zone and chordae seamlessly.
  
  
  RESULTS
  There was no hospital death, and mitral regurgitation at discharge was none or trivial in all patients. During 1-59 months (mean 12.7) of complete follow-up, death, infection or hemolysis was not observed. In one patient, mitral regurgitation recurred 8 months postoperatively because the fixation suture of the pericardium to the papillary muscle broke. The valve was re-repaired with re-attaching the leg of the pericardium. Regurgitation was less than moderate in all other patients. One patient with rheumatic lesion who underwent anterior leaflet repair and Maze operation suffered minor stroke 1 month postoperatively but fully recovered.
  
  
  CONCLUSIONS
  Seamless reconstruction of leaflets and chordae with pericardium seemed promising to repair extensively destructed mitral valve.
authors.affiliation: Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, Nakamura-ku, Nagoya , Japan cvs1@nagoya-1st.jrc.or.jp.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Ito
authors.affiliation: Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, Nakamura-ku, Nagoya , Japan.
authors.forename: Atsuo
authors.initials: A
authors.lastname: Maekawa
authors.affiliation: Department of Cardiovascular Surgery, Matsumoto Kyoritsu Hospital, Matsumoto, Nagano, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Aoki
authors.affiliation: Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, Nakamura-ku, Nagoya , Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hoshino
authors.affiliation: Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, Nakamura-ku, Nagoya , Japan.
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Hayashi
authors.affiliation: Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, Nakamura-ku, Nagoya , Japan.
authors.forename: Sadanari
authors.initials: S
authors.lastname: Sawaki
authors.affiliation: Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, Nakamura-ku, Nagoya , Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Yanagisawa
authors.affiliation: Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, Nakamura-ku, Nagoya , Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Tokoro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002815:Chordae Tendineae / Q000601:surgery*; D004452:Echocardiography; D004696:Endocarditis / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery; D010496:Pericardium / Q000637:transplantation*; D019651:Plastic Surgery Procedures; D016896:Treatment Outcome; D055815:Young Adult
keywords: Endocarditis; Mitral valve repair; Pericardium