Abstract
Aim: Mitral valvular–ventricular interaction includes the following mechanisms. 1. Chordal annulo-papillary connection preventing excessive diastolic dilatation. 2. Systolic closure of the valve during isovolumic left ventricular (LV) contraction causes shortening of the LV long axis. This effect “turbo-charges” the systolic function of the LV. 3. The diastolic baffle effect of the anterior leaflet improves laminar flow through the LV. 4. The dynamic action of the annulus improves diastolic LV filling (“lusitropy”). In chordal-sparing valve replacement the anterior leaflet (AML) is excised or modified, sacrificing the systolic turbo-charging and the diastolic baffle support of LV function. These losses are sufficient to explain equal survival for mitral repair versus replacement in ischaemic cardiomyopathy despite a high recurrence rate of mitral incompetence in the repair group. However, full retention of the native anterior leaflet risks the development of LV outflow tract obstruction (LVOTO).
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