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

Area of Science:

• Cardiovascular Surgery
• Cardiac Imaging
• Valvular Heart Disease

Background:

• Posterior leaflet prolapse is a common cause of mitral regurgitation.
• Surgical repair aims to restore normal valve morphology and function.
• 3D transoesophageal echocardiography is crucial for assessing mitral valve anatomy and repair outcomes.

Purpose of the Study:

• To evaluate the morphological reconstruction of the mitral valve after triangular resection and neochordal replacement for posterior leaflet prolapse.
• To compare the effectiveness of these two surgical techniques using 3D transoesophageal echocardiography.

Main Methods:

• Retrospective analysis of 46 patients with posterior leaflet prolapse undergoing mitral valve repair (20 triangular resection, 26 neochordal replacement).
• Inclusion of 60 controls without valvular heart disease.
• Comprehensive 3D transoesophageal echocardiography assessment of mitral valve morphology.
• Mid-term follow-up of repair durability using transthoracic echocardiography.

Main Results:

• Prolapsed valves showed significantly larger annular size, leaflet tenting, leaflet area, coaptation line lengths, and aortomitral angle compared to controls.
• Post-repair, tenting volume, exposed posterior leaflet area, and coaptation line lengths returned to normal ranges.
• Both techniques yielded comparable baseline and post-repair echocardiographic parameters, with similar mid-term residual regurgitation.

Conclusions:

• Triangular resection and neochordal replacement achieve comparable structural and functional restoration in mitral valves with posterior leaflet prolapse.
• Resection of the prolapsed segment does not significantly alter coaptation geometry.
• The resection technique may contribute to achieving a normal posterior leaflet ratio.