Eur J Cardiothorac Surg 2007;32:936. doi:10.1016/j.ejcts.2007.08.032
Copyright © 2007, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
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Dissection of the posterior mitral leaflet
Roberto Lorussoa,*,
Giuseppe De Ciccoa,
Sandro Gelsominob,
Carlo Fuccia
a Cardiac Surgery Unit, Civic Hospital, Brescia, Italy
b Experimental Cardiac Surgery Unit, Careggi Hospital, Florence, Italy
Received 27 April 2007;
received in revised form 6 August 2007;
accepted 14 August 2007.
* Corresponding author. Address: Cardiac Surgery Unit, Civic Hospital, Piazzale Spedali Civili, 1, 25125 Brescia, Italy. Tel.: +39 030 3995636; fax: +39 030 3995004. (Email: roberto_lorusso{at}iol.it).
Key Words: Mitral valve • Mitral valve repair • Rheumatic • Valve disease
A 63-year-old man presented with severe mitral insufficiency due to rheumatic disease. Transesophageal echocardiography showed a dissection of the posterior mitral leaflet (Fig. 1
). Intraoperatively, a saccular pouch of the posterior leaflet and chordal elongation were observed (Fig. 2
). Successful repair included approximation of the pouch free edges, edge-to-edge technique, and annuloplasty.
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Fig. 1. Preoperative transesophageal echocardiography showing the double-layer profile (arrows) of the posterior leaflet of the mitral valve due to leaflet dissection which caused severe mitral regurgitation with an eccentric jet towards the mitroaortic continuity, resembling a flailing segment although no ruptured chordae could be demonstrated.
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Fig. 2. Surgical finding showing a double-layer pouch mainly involving the central scallop and a portion of the posteromedial scallop of the posterior leaflet, with elongation of the free-margin chordae of both leaflets at this level.
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