Triangular resection versus neochordal replacement for posterior leaflet prolapse: a morphological assessment

To evaluate the morphological reconstruction as assessed by 3D transoesophageal echocardiography after triangular resection and neochordal replacement in the treatment of posterior leaflet prolapse.

We retrospectively selected 46 patients with isolated posterior leaflet prolapse who were undergoing mitral valve repair using triangular resection (n = 20) and neochordal replacement (n = 26) techniques. Sixty patients without valvular heart disease were also included as the control group. Thorough 3D transoesophageal echocardiography inspections were performed for the entire cohort, and morphological parameters of mitral valve complex were measured and compared. Mid-term repair durability was followed up by transthoracic echocardiography.

The baseline parameters, including annular size, leaflet tenting, leaflet area, coaptation line lengths and aortomitral angle, were significantly larger in prolapsed valves. After repair, tenting volume, exposed posterior leaflet area and coaptation line lengths were restored to the normal range. Baseline clinical characteristics and 3D transoesophageal echocardiography parameters were comparable in patients treated with 2 techniques, and all parameters remained comparable between the resection and the non-resection groups after repair, except for exposed posterior leaflet area and posterior leaflet ratio. At 62.2 ± 18.5 months after surgery, degrees of residual regurgitation were similar between 2 techniques.

Triangular resection and neochordal replacement can achieve comparable restoration to structural normality and functional competency of mitral valves with posterior leaflet prolapse. Resection of prolapsed segment does not significantly affect coaptation geometry but instead may aid in achieving normal posterior leaflet ratio.