title: Transapical off-pump Neochord implantation on bileaflet prolapse to treat severe mitral regurgitation.
abstract: A 74-year old lady was admitted for the presence of a symptomatic severe mitral regurgitation (MR) due to bileaflet prolapse. The patient refused any surgical conventional procedure because of severe arthrosis and osteoporosis documented by previous fractures requiring knee and hip replacements, and was sent directly to us for transapical off-pump mitral valve repair with Neochord implantation (TOP-MINI procedure). The TOP-MINI procedure was performed under general anaesthesia and transoesophageal echocardiographic guidance. Four Neochordae were implanted on the posterior leaflet and two on the anterior leaflet in order to correct a residual anterior prolapse that was not seen at preoperative screening. After 11 months of follow-up, the patient presented with recurrence of symptomatic moderate MR due to rupture of one of two neochordae implanted on the anterior leaflet and new onset of atrial fibrillation. The patient underwent uneventful mitral valve replacement.
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy colli.andrea.bcn@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Colli
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bellu
authors.affiliation: Department of Medicine, Institute of Anesthesia, University of Padua, Padua, Italy.
authors.forename: Demetrio
authors.initials: D
authors.lastname: Pittarello
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
mesh_terms: D000368:Aged; D002815:Chordae Tendineae / Q000000981:diagnostic imaging / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging / Q000601:surgery; D018084:Ultrasonography, Interventional
keywords: Mitral regurgitation; Transapical mitral valve repair