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J Thorac Cardiovasc Surg 2003;126:942-943
© 2003 The American Association for Thoracic Surgery

Editorial

"Cinching" the mitral valve

^a Department of Thoracic and Cardiovascular Surgery and the Heineman Research Laboratories at the Carolinas Medical Center, Charlotte, NC, USA

Received for publication April 28, 2003; accepted for publication June 3, 2003.

^* Address for reprints: Francis Robicsek, MD, PhD, The Carolinas Heart Institute, 1001 Blythe Blvd, Suite 300, Charlotte, NC 28203, USA
tjohn@sanger-clinic.com

The first 20% of the full text of this article appears below.

This method may well prove to have a place in the surgical correction of mitral insufficiency.—John Borrie, 1951¹

Mitral regurgitation may be caused either by structural defects of the valve apparatus or by discrepancy between the size of the orifice and the leaflet surface available to seal it during ventricular systole. Although the dividing line between these groups is distinct, treating modalities do overlap; surgical narrowing of the orifice may correct not only annular dilatation but in some cases faulty valve function as well.

Methods intended to restrict the mitral orifice with the heart open and the valve exposed are used routinely in contemporary cardiac surgery. The proposed procedure of Kollar,² however, accomplishes annular narrowing externally, without exposing the mitral orifice and without the need for cardiopulmonary bypass.

Restricting the size of the mitral orifice by external "cinching" is nothing new. As a matter of fact, surgery for mitral regurgitation began this way. Interestingly enough, these initial experiments were designed not to correct mitral incompetence but to create mitral stenosis to provide animal models as "proving grounds" for methods to treat mitral stenosis. This was already the aim of Bertrand Bernheim, a distinguished surgeon of the very early 20th century who was also the first to treat successfully a popliteal aneurysm with resection and replacement with a 15-cm segment of the saphenous vein³—an accomplishment described by Matas as a "splendid contribution to vascular surgery."⁴ Bernheim, in 1909, . . . [Full Text of this Article]