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Failed mitral valve repair caused by polypropylene suture.
Buu-Khanh Lam1, A Marc Gillinov, Delos M Cosgrove
1Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA.
The Annals of Thoracic Surgery
|November 7, 2003
Summary
Suture material choice is critical in mitral valve repair. A polypropylene suture tail eroded heart valve tissue, causing recurrent mitral regurgitation and requiring re-repair.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Cardiac Anatomy
Background:
- Degenerative mitral valve disease necessitates surgical intervention.
- Mitral valve repair aims to restore native valve function, often using annuloplasty and leaflet repair techniques.
- Polypropylene sutures have been used in cardiac procedures, but their material properties require careful consideration.
Observation:
- A patient undergoing mitral valve repair experienced recurrent mitral regurgitation six years post-surgery.
- The free edge of the anterior mitral leaflet and its chordae showed erosion.
- A cut tail of a polypropylene suture from the initial repair was identified as the causative agent.
Findings:
- The polypropylene suture tail had eroded the delicate mitral valve leaflet and chordal tissue.
- Recurrent mitral regurgitation was attributed to suture-induced leaflet damage.
- Successful re-repair was achieved using chordal transfer.
Implications:
- This case highlights a potential complication of using polypropylene sutures in mitral valve repair.
- Careful placement of suture tails and knots away from leaflet tissue is crucial when using non-absorbable sutures.
- Soft, braided sutures are generally preferred for leaflet approximation to minimize tissue trauma and risk of erosion.