Triangular Resection to Treat Extensive Anterior Mitral Valve Leaflet Prolapse: Technical Tips

Myxomatous degeneration of the anterior mitral leaflet is difficult to treat with chordal replacement. Triangular resection offers effective results because it can remove any redundant prolapsed lesion.

To optimize surgical outcomes, we developed a marking stitch to decide on the cut range. Between 2004 and 2024, we repaired 382 type 2 mitral regurgitation, 66 of which were anterior prolapse. Twenty-four patients with myxomatous extensive anterior leaflet prolapse underwent triangular resection. We followed the patients with echocardiogram yearly. A suture was placed on both sides of the lesion and was tied. A leakage test was performed. If no leakage was found, we marked the cut line, removed the suture, cut the marked line triangularly, and sutured by two layers with 6-0 polypropylene suture. Then implant the annuloplasty ring.

All patients were successfully repaired. One patient with Barlow disease was re-repaired 8 years postoperatively, because of recurrent mitral regurgitation. The other 23 patients had no mitral regurgitation graded as more than mild, and 1-21 year follow-up reports they have remained healthy.

Myxomatous extensive anterior mitral prolapse can be effectively repaired by the triangular resection. Our tips for deciding on the cut range can be useful.