title: Posterior mitral annuloplasty for enhancing mitral leaflet coaptation: using a strip designed for placement in the posterior annulus.
abstract: BACKGROUND
  In patients with mitral valve regurgitation (MR), posterior mitral annuloplasty (PMA) was performed for mitral valve repair using a strip designed for placement in the posterior annulus, sparing the anterior annulus and anterior half of the commissures.
  
  
  METHODS
  Between September 2009 and October 2013, we performed PMA using a novel strip in 74 consecutive patients with MR greater than 3+. Procedures associated with mitral valve repairs were performed in 41 patients (56.9 %), including new chord placement for leaflet prolapse (n=30), patch valvuloplasty for posterior chord rupture (n=4), and posterior leaflet augmentation (n=15). All patients were analyzed by serial echocardiographic follow-up, and preoperative and postoperative computed tomography was performed in 10 randomly selected patients.
  
  
  RESULTS
  Hospital death occurred in two patients (2.7 %), and 72 survived patients were completely followed up. At a mean follow-up of 37.2 ± 15.0 months, the MR grade was zero or 1+ in 64 patients (88.9 %), 2+ in 7 patients (9.7 %), and 3+ in one patient (1.4 %). The mean indexed valve area and mean valve gradient were 1.7 ± 0.4 cm(2)/m(2) and 3.5 ± 1.2 mmHg, respectively. The mean leaflet coaptation height in early systole was 12.8 ± 3.5 mm. During the cardiac cycle, the repaired valves exhibited dynamic changes of 19.5 ± 9.3 % in the septo-lateral dimensions. No early conversions to valve replacements or late reoperations occurred. None of the patients with remnant or recurrent MR experienced hemolysis.
  
  
  CONCLUSIONS
  PMA using a novel strip showed a sufficient coaptation height secondary to reduction of the septo-lateral annular dimensions and dynamic changes in the dimensions. It can be expected to be an alternative mitral annuloplasty technique with satisfactory results.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School, 20 Geonji-Ro, Deokjin-Gu, Jeonju, Chonbuk, 561-712, Republic of Korea. kim77jh@gmail.com.|Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Chonbuk, 561-712, Republic of Korea. kim77jh@gmail.com.
authors.forename: Jong Hun
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School, 20 Geonji-Ro, Deokjin-Gu, Jeonju, Chonbuk, 561-712, Republic of Korea. tcskim@jbnu.ac.kr.
authors.forename: Kyung Hwa
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School, 20 Geonji-Ro, Deokjin-Gu, Jeonju, Chonbuk, 561-712, Republic of Korea. jobchoi@jbnu.ac.kr.|Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Chonbuk, 561-712, Republic of Korea. jobchoi@jbnu.ac.kr.
authors.forename: Jong Bum
authors.initials: JB
authors.lastname: Choi
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School, 20 Geonji-Ro, Deokjin-Gu, Jeonju, Chonbuk, 561-712, Republic of Korea. jhkuh@hanmail.net.|Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Chonbuk, 561-712, Republic of Korea. jhkuh@hanmail.net.
authors.forename: Ja Hong
authors.initials: JH
authors.lastname: Kuh
mesh_terms: D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000379:methods*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*