European Journal of Cardio-Thoracic Surgery, Vol 10, 874-878, Copyright © 1996 by European Association for Cardio-thoracic Surgery
Mitral valve repairs using the posterior tricuspid leaflet and chordae. Technique and results
U Hvass, D Chatel, J Caliani and M Oroudji
Hopital Bichat, F-Paris, France.
OBJECTIVE: Some mitral lesions are still out of reach of conventional
repairs. Transferring the posterior leaflet of the tricuspid valve with its
subvalvular apparatus to the mitral valve is a new autograft technique
which has allowed us a conservative approach in cases where repair seemed
less predictable. METHODS: After removing the posterior tricuspid leaflet
with its subvalvular apparatus, the tricuspid autograft was inserted by
implanting its papillary muscle onto the mitral papillary muscle and then
by suturing the leaflet tissue in place. The tricuspid valve was
subsequently repaired by annular plication and leaflet suture. A tricuspid
ring was used in all but the first case. RESULTS: The age of the seven
patients ranged from 20 to 70 years. Postoperative controls by
transesophageal echocardiography showed no leaks in five and trivial in one
on the site of the mitral repair. On the tricuspid valve, we found a
moderate leak in the first case and trivial or none in the following cases,
where a tricuspid ring was used. With a 3-12 month follow-up the results
are stable. CONCLUSIONS: This autograft technique is reproducible, and
extends the field of mitral valve repairs. Compared to segments of mitral
homografts, we prefer the intraoperative availability of natural chordae
and valvular leaflet that have no immunological interference. The patient
is his own tissue bank and the tricuspid valve can be repaired with a very
low risk of significant dysfunction.
