title: Parannular Elliptical Posterior Resection: A Low-Impact Reparative Technique for Mitral Valve Prolapse.
abstract: OBJECTIVE
  Although effective, Carpentier technique for mitral regurgitation presents two "Achille's heel": the resection of the whole prolapsing section of posterior mitral leaflet (PML) including chordae tendinae and the annular distortion due to plication. An alternative technique of limited PML resection, which preserves mitral anatomy decreasing the impact on valve function, and 9-year outcome are presented.
  
  
  METHODS
  Since April 2005 till March 2014, of 205 patients affected by mitral prolapse scheduled for repair (mitral valve repair), 54 patients have been included in the study. The rationale of the new technique was to limit PML resection to achieve a fair reduction of the prolapsing scallop(s) height, to avoid leaflet and annular distortion, and to spare the coaptation surface and other substantial structures. According to the observation that the posterior smooth zone of PML is quite free from chordal insertions, an elliptical slice of tissue was resected from this area. Annuloplasty and neochordal insertion when indicated completed the procedure.
  
  
  RESULTS
  Up to 9 years of follow-up was 98% complete. One in-hospital death, two late noncardiac deaths, one redo operation due to endocarditis were reported. On late follow-up, 92% patients were on New York Heart Association class I. Late echocardiography showed stability of repair (regurgitation grade of ≤1 in 92% of patients). Nearly two third of valves preserved good PML mobility.
  
  
  CONCLUSIONS
  The parannular elliptical posterior leaflet resection, providing excellent stable midterm results, seems to be a safe alternative method for repair of PML prolapse. It avoids distortion and weakening of annulus and leaflet, and it allows restoring a proper coaptation surface and maintains a satisfactory PML motion.
authors.affiliation: From the Department of Cardiac Surgery, S. Maria della Misericordia Hospital, Perugia, Italy.
authors.forename: Uberto
authors.initials: U
authors.lastname: Da Col
authors.forename: Simone
authors.initials: S
authors.lastname: Perticoni
authors.forename: Enrico
authors.initials: E
authors.lastname: Ramoni
mesh_terms: D000328:Adult; D000368:Aged; D002815:Chordae Tendineae / Q000000981:diagnostic imaging / Q000601:surgery; D018618:Echocardiography, Doppler, Color / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D058386:Mitral Valve Annuloplasty / Q000379:methods; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome