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Eur J Cardiothorac Surg 2006;29:1052-1055
© 2006 Elsevier Science NL

How-to-do-it

The upside-down technique.

A novel method to correct posterior leaflet prolapse

Cardiac Surgery Unit, San Raffaele University Hospital, 20132 Milan, Italy

Received 17 January 2006; received in revised form 2 March 2006; accepted 10 March 2006.

^_* Corresponding author. Tel.: +39 02 26437111; fax: +39 02 26437125. (Email: francesco.maisano{at}hsr.it).

The upside-down technique is a method for ‘in situ’ secondary cordae transposition for posterior leaflet lesions. The segmental prolapse of the posterior leaflet is corrected by rotating the resected segment upside-down and reattaching it to the annulus and adjacent leaflet segments. As the procedure is completed, the original annular attachment becomes the new free edge. The secondary chords, originally positioned at the base of the segment, become primary chordae. It is indicated in all cases when quadrangular resection is not feasible such as in case of calcified annulus, posterior leaflet hypoplasia, or when the prolapsing portion is wide.

Key Words: Mitral valve repair • Secondary chordae • Prolapse