title: A new method for the adjustment of neochordal length: the adjustable slip knot technique.
abstract: The use of expanded polytetrafluoroethylene (ePTFE) sutures for the correction of mitral valve prolapse has become a standardized procedure. Adjustment of neochordal length is crucial to the efficacy of this technique. Various methods have been described for this purpose; however, the fine adjustment of neochordal length is technically challenging. We describe a simple and effective technique for the implantation of neochordae, which we have termed the 'adjustable slip knot technique'. The first step of this technique is reinforcement of the papillary muscle by a Teflon pledget with or without polytetrafluoroethylene (CV-4) loops. The second step is the formation of a neochordal loop by introducing an ePTFE suture between the affected mitral leaflet and the papillary muscle or ePTFE loops. The third step is the adjustment of the length of neochordae. The formation of a slip knot in one arm of the ePTFE suture is the pivot of this technique. The neochordal loop can be constricted by the application of tension to one arm of the suture. We applied this technique in 5 patients with satisfactory results.
authors.affiliation: Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital, Miyazaki, Japan yanomitsu@me.com.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Yano
authors.affiliation: Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital, Miyazaki, Japan.
authors.forename: Syuuhei
authors.initials: S
authors.lastname: Sakaguchi
authors.affiliation: Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital, Miyazaki, Japan.
authors.forename: Kohji
authors.initials: K
authors.lastname: Furukawa
authors.affiliation: Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital, Miyazaki, Japan.
authors.forename: Eisaku
authors.initials: E
authors.lastname: Nakamura
mesh_terms: D000328:Adult; D000368:Aged; D001672:Biocompatible Materials; D002815:Chordae Tendineae / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000601:surgery*; D010210:Papillary Muscles / Q000601:surgery; D011138:Polytetrafluoroethylene; D013536:Suture Techniques
chemical_list: D001672:Biocompatible Materials; D011138:Polytetrafluoroethylene
keywords: Artificial chordae; Mitral valve prolapse; Mitral valve repair