[Residual, recurrent mitral regurgitation after mitral valve reconstruction: differences in lesion and operation...

Patients developing residual or recurrent mitral regurgitation (MR) increased to moderate or severe grade after mitral valve reconstruction for MR were investigated by correlating the lesion and operation method with the echocardiographic course of postoperative MR. Postoperative moderate or severe grade MR [more than 4.0 cm2 color Doppler flow area on postoperative transesophageal echocardiography (TEE)] occurred in 21 of 80 mitral valve reconstruction patients. If residual MR caused more than 2.0 cm2 color Doppler flow area on intraoperative TEE, the MR increased to moderate or severe grade during the follow-up period. Postoperative moderate or severe MR occurred more frequently in lesions of the anterior mitral leaflet than the posterior mitral leaflet (45.8% vs 6.5%, p < 0.001), and in elongated chordae than in torn chordae (52.9% vs 14.3%, p < 0.005). Chordal shortening for elongated chordae could correct MR at operation but MR recurred and increased gradually to moderate or severe grade in half of these cases. Chordal reconstruction with polytetrafluorethylene suture is expected to achieve better results than chordal shortening. The causes of postoperative MR could usually be identified by comparative investigation of echocardiographic course, lesion, and operation method. Postoperative moderate or severe MR occurs more often in lesions of the anterior mitral leaflet or cases of elongated chordae. Residual MR should be suppressed to less than 2.0 cm2 color Doppler flow area on intraoperative TEE.