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J Thorac Cardiovasc Surg 2005;130:614-615
© 2005 The American Association for Thoracic Surgery

Letters to the Editor

A new technique for repair of mitral paravalvular leak?

Igor E. Konstantinov, MD, PhD

Division of Cardiovascular Surgery, Hospital for Sick Children, 555 University Ave, Toronto, Ontario M5G 1X8, Canada

To the Editor:

I read with interest a recent report of Mangi and Torchiana. 1 Go They reported successful repair of anterior mitral periprosthetic leaks after mitral valve replacement in 2 patients and made the following statement: "Here we propose a simple technique for repair of selected mitral paravalvular leaks that incorporates healthy, full-thickness autologous tissue into the repair and has promising durability."

This technique, however, is not novel. It seems appropriate to point out to Mangi and Torchiana that this technique had already been proposed 7 years ago, when my colleagues and I reported it. 2 Go It is amazing to see that the technique described by Mangi and Torchiana is exactly the same as the one that was first used by us more than 10 years ago (Figure 1, A).


Figure 1
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  		Figure 1. A, To close anterior mitral periprosthetic leak, sutures are applied through atrial septum adjacent to sewing ring of prosthesis. Ligament of Todaro and location of atrioventricular node are identified before suture placement. B, Posterior mitral periprosthetic leak is repaired by sutures passed through posterior left atrial wall. Care is taken to avoid damage to coronary sinus and left circumflex coronary artery. C, Aortic periprosthetic leak is repaired through incision in right ventricular outflow tract by passing sutures through ventricular septum. D, Aortic periprosthetic leak is repaired through right atrium. Distinct anatomic landmarks, such as triangle of Koch, membranous septum, and conus aorticus, are identified before suture placing. Sutures are then placed through right atrial wall and passed through lowest part of the conus aorticus above membranous septum. (Reproduced with permission from Konstantinov IE, Franzen SF, Olin CL. Periprosthetic Leaks and Valve Dehiscence: Alternative Methods of Repair. J Heart Valve Dis. 1997;6:281–7.)

 
Repair of periprosthetic leaks can indeed be very difficult and is often frustrating, as often there is a lack of strong tissue in the periprosthetic area to place direct sutures securely. For this reason, we decided to repair periprosthetic leaks with full-thickness autologous tissue. Further, and more importantly, we applied this concept not only to anterior but also posterior mitral (Figure 1, B) and aortic (Figure 1, C and D) periprosthetic leaks. 2 Go During the last decade, we have maintained that these alternative methods of repair with healthy autologous tissues are superior to direct suture closure of the leak. It is gratifying to see that others have started to use this technique with good results.

References

  1. Mangi AA, Torchiana DF. A technique for repair of mitral paravalvular leak. J Thorac Cardiovasc Surg. 2004;128:771-772.[Free Full Text]
  2. Konstantinov IE, Franzen SF, Olin CL. Periprosthetic leaks and valve dehiscence. alternative methods of repair. J Heart Valve Dis. 1997;6:281-287.[Medline]



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