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The Journal of Thoracic and Cardiovascular Surgery, Vol 101, 495-501, Copyright © 1991 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
TE David, J Bos and H Rakowski
Expanded polytetrafluoroethylene sutures have been used for replacement of
diseased chordae tendineae during reconstructive procedures on the mitral
valve in 43 patients. There were 28 men and 15 women whose mean age was 55
years, range 21 to 76. Three fourths of the patients were in New York Heart
Association class III or IV. Replacement of primary chordae tendineae of
the anterior leaflet was performed with 4-0 or 5-0 polytetrafluoroethylene
sutures. A double-armed suture was passed twice through the fibrous portion
of the papillary muscle head and tied down. Each arm of the suture was
brought up to the free margin of the leaflet and passed through the area
where the native chorda was attached. After the lengths of the two arms
were adjusted, the ends were tied together on the ventricular side of the
leaflet. Thirty patients had degenerative disease of the mitral valve; the
incompetence was due to prolapse of the anterior leaflet in 14 patients and
prolapse of the anterior and posterior leaflets in 16. Eleven patients had
rheumatic mitral valve disease: four had stenosis, three had regurgitation,
and four had mixed lesions. Two patients had ischemic mitral regurgitation
caused by rupture of a papillary muscle head. There were no operative
deaths. Patients have been followed up from 5 to 61 months, mean 13.
Doppler echocardiographic studies were performed at regular intervals after
the operation and revealed normal mitral valve function in most patients
There were two failures that necessitated mitral valve replacement: one
because of acute mitral regurgitation and the other because of hemolysis.
There have been two late deaths, neither one valve related. Replacement of
chordae tendineae with polytetrafluoroethylene sutures is simple and allows
for reconstruction of the mitral valve in many patients who would otherwise
require mitral valve replacement. Because our patients have been followed
up for a limited time, the long-term results of this procedure remain
unknown.
ARTICLES
Mitral valve repair by replacement of chordae tendineae with polytetrafluoroethylene sutures
Division of Cardiovascular Surgery, University of Toronto, Ontario, Canada.
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U. Hvass, J. Calliani, I. Nataf, J. M. Julliard, and A. Vahanian Transfer of the posterior tricuspid leaflet and chordae for mitral valve repair J. Thorac. Cardiovasc. Surg., September 1, 1995; 110(3): 859 - 861. [Full Text]
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T. E. David Update on Mitral Valve Repair Ann. Thorac. Surg., May 1, 1995; 59(5): 1257 - 1258. [Full Text]
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T. Shimono, H. Yuasa, T. Mizumoto, K. Hatanaka, H. Kusagawa, and I. Yada New surgical method of chordal replacement for mitral valve incompetence with echocardiographic guidanceAn experimental study J. Thorac. Cardiovasc. Surg., October 1, 1994; 108(4): 719 - 726. [Abstract] [Full Text]
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C. Zussa, E. Polesel, U. D. Col, M. Galloni, and C. Valfre Seven-year experience with chordal replacement with expanded polytetrafluoroethylene in floppy mitral valve J. Thorac. Cardiovasc. Surg., July 1, 1994; 108(1): 37 - 41. [Abstract] [Full Text]
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Y. Okita, S. Miki, Y. Ueda, T. Tahata, T. Sakai, and K. Matsuyama Mitral valve replacement with maintenance of mitral annulopapillary muscle continuity in patients with mitral stenosis J. Thorac. Cardiovasc. Surg., July 1, 1994; 108(1): 42 - 51. [Abstract] [Full Text]
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