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J Thorac Cardiovasc Surg 2007;133:861-864
© 2007 The American Association for Thoracic Surgery

Editorial

Stentless mitral valves

Robert W.M. Frater, MD*

Department of Cardiothoracic Surgery, Montefiore Medical Center, Bronx, NY.

Received for publication September 6, 2006; accepted for publication September 20, 2006.

* Address for reprints: Robert W. M. Frater, MD, Montefiore Medical Center, Department of Cardiothoracic Surgery, 1575 Blondell Avenue, Suite 125, Bronx, NY 10467. (Email: Rwmfglycar@aol.com).

The first 300 words of the full text of this article appear below.

GoThe natural mitral valve is a complex and finely tuned structure, very well suited to its purpose. It has the unusual feature of having fingerprint anatomic variation from heart to heart and yet the correct essentials for optimal function in each heart. Among the many features is that the mural annulus expands for flow and narrows for closure and that the multiscalloped posterior leaflet makes expansion and contraction possible. In diastole the scallops are separate; in systole they are compressed into a shelf.

The chordae are of two types, despite their extreme variability: one to align the free edges and one to bear the load of the closed valve and transmit that load to the ventricular wall and aid in systolic ejection.

The Encyclopedia Britannica of 1895 described all of the devices for allowing fluid to travel in one direction and preventing it from traveling in an opposite direction that had been developed by the engineers of the Industrial Revolution. The principle of every type of mechanical valve that we have adapted for use in the heart in the last 45 years is to be found there. There are even flap valves made of leather. There is no valve with a dynamic orifice that enlarges for flow and narrows for closure. There is no valve with downstream support divided between one set of chordae to align the leaflet edges and one set to support the load of the closed valve. There is no valve that resembles the natural mitral valve.

Surgeons started trying to design artificial mitral valves in the late 1950s. Most sought mechanical solutions. If we define success as replacement of the mitral valve followed by discharge of a live patient from the hospital, then the first success followed the implantation of a stentless mitral valve made by . . . [Full Text of this Article]


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