Hourglass-shaped resection technique for repair of tall mitral valve posterior leaflet prolapse

We developed a repair technique for an excessively high posterior leaflet of the mitral valve. This is an improvement of the folding plasty.

The resection shape is that of an hourglass rather than a quadrangle. The vertical sides of the quadrangle curve inward, which helps to prevent the curtain effect or restriction that is common in the large triangular resection or folding plasty. We used hourglass resection for 26 tall posterior leaflets (53.8% were Barlow disease) and triangular resection for 23 posterior leaflets of normal height (without Barlow disease).

All surgeries were performed successfully. There was no mortality, no mitral regurgitation greater than moderate, and no systolic anterior motion of the anterior leaflet in the early postoperative period. One patient required a second pump run, and another required a second repair procedure. The mean follow-up period was 2.3 years (0.3-4.9 years) for the hourglass resection and 2.8 years (0.1-4.9 years) for the triangular resection. One patient in the triangular resection group died of rectal cancer. One patient treated with the hourglass resection via minithoracotomy required re-repair 1 month postoperatively due to suture dehiscence. For the hourglass and triangular resection groups, the most recent postoperative echocardiogram revealed no mitral regurgitation in 18 and 20 cases, respectively; mild mitral regurgitation in 7 and 3 cases, respectively; and moderate mitral regurgitation in 1 and 0 cases, respectively.

The short-term results of our strategy for posterior leaflet repair appear promising.