Abstract
The preservation of the subvalvular apparatus during mitral valve replacement is necessary to maintain the geometry and function of the left ventricle. Although several complete or partial chordal preservation methods have been described, some continue to preserve only the posterior chordal attachments. This is due to a fear of possible patient prosthetic valve mismatch with many well-known chordal preservation techniques. We describe a simple method of preservation of both the leaflets and chordal attachments using a simple eversion technique. In our technique, we retain all the mitral valvular and subvalvular tissue. The excised leaflet ends are everted by the valve sutures to avoid interference with the prosthetic valve leaflets.
Highlights
Mitral valve repair is the ideal surgical management for a variety of mitral valve pathological states as it provides a competent, non-obstructed valve without compromising the left ventricular function
We describe a simple and reproducible eversion technique of total chordal preservation during mitral valve replacement, which retains the entire subvalvular apparatus as well as the leaflets without ventricular outflow tract obstruction or interference by retained chordae and leaflet tissue
Multiple slits are made into the posterior mitral valve leaflet (PML), starting at the midportion of the P2 segment followed by additional cuts into the P1 and P3 segments, in order to ensure enough space for an adequate or even larger sized prosthetic valve (Figure 11)
Summary
Mitral valve repair is the ideal surgical management for a variety of mitral valve pathological states as it provides a competent, non-obstructed valve without compromising the left ventricular function. With the recent advancements and refinements in techniques and evolution of the low profile bi-leaflet mechanical valves, various methods of total chordal preservation are being described to preserve left ventricular systolic function. The major concern is to avoid the interference of the mechanical prosthetic function by the portions of the retained subvalvular apparatus with reduced risk of left ventricular outflow tract obstruction. We describe a simple and reproducible eversion technique of total chordal preservation during mitral valve replacement, which retains the entire subvalvular apparatus as well as the leaflets without ventricular outflow tract obstruction or interference by retained chordae and leaflet tissue. Multiple slits are made into the posterior mitral valve leaflet (PML), starting at the midportion of the P2 segment followed by additional cuts into the P1 and P3 segments, in order to ensure enough space for an adequate or even larger sized prosthetic valve (Figure 11).
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