Mitral valve repair for extended commissural prolapse involving complex prolapse

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Repair
• Thoracic Surgery

Background:

• Extended commissural prolapse involves complex mitral valve leaflet prolapse, often due to chordal issues.
• Mitral regurgitation can result from such prolapse, necessitating surgical intervention.
• This study focuses on a specific subset of patients undergoing mitral valve repair.

Purpose of the Study:

• To evaluate the efficacy of various mitral valve repair techniques for extended commissural prolapse.
• To assess the outcomes of reconstructive surgical methods in patients with complex mitral valve prolapse.
• To identify optimal repair strategies for mitral regurgitation caused by commissural prolapse.

Main Methods:

• Retrospective review of 21 patients with extended commissural prolapse undergoing mitral valve repair (June 1991-January 2005).
• Analysis of etiologies (degenerative vs. infective endocarditis) and lesion distribution (posteromedial, anterolateral, bilateral).
• Detailed description of reconstructive techniques employed, including leaflet folding plasty, resection-suture, sliding technique, commissuroplasty, and chordal shortening.

Main Results:

• No perioperative deaths occurred in the 21 patients.
• Postoperative mitral regurgitation was none/trivial in 19 patients and mild in 2.
• Mean follow-up was 54 months, with no re-operations required and one late non-cardiac death.

Conclusions:

• Mitral valve repair for extended commissural prolapse is a satisfactory surgical option.
• Leaflet folding plasty and its modifications are effective, particularly for cases requiring extensive commissural leaflet resection.
• Surgical repair demonstrates durable results with low rates of morbidity and re-intervention.