[Operative procedures for mitral prolapse and its clinical results]

Mitral valve plasty is the very important procedure for treatment of mitral regurgitation from the view point of post operative quality of life because patients may be possible to be free from postoperative drug therapy especially when the normal sinus rhythm is restored even if the concomitant maze procedure is necessary. In this report, 36 patients who underwent mitral valve plasty for mitral regurgitation were evaluated. In 18 patients who had posterior leaflet prolapse, McGoon's procedure was performed. Two of them required secondary mitral valve replacement 4 days after operation. Reoperation disclosed tissue detachment at the mitral annulus sutures which were not reinforced by a ring. It was considered that annular ring plasty is preferable after resection of prolapsed posterior leaflet by McGoon's procedure. Out of 18 patients who had mitral valve prolapse including anterior leaflet, 8 patients underwent such conventional procedures as transfer of chordae tendinae, leaflet resection and shortening of chordae. Four patients resulted in second look mitral valve replacement 11 days to 1 month after mitral valve plasty. On the contrary, the clinical results of repair of chordae tendineae with artificial chordae of extended polytetrafluoroethylene (ePTFE) were good. It is concluded that the resection of prolapsed leaflet and reconstruction of the annulus with reinforcement using a prosthetic ring is preferable for the posterior leaflet prolapse. For the anterior leaflet prolapse, good results can be obtained by replacement of chordae tendineae with ePTFE sutures.