Chordal translocation: secondary chordal cutting in conjunction with artificial chordae for preserving valvular-ventricular interaction in the treatment of functional mitral regurgitation.

摘要

BACKGROUND AND AIM OF THE STUDY: Functional mitral regurgitation (FMR) with leaflet tethering is a serious complication related to dilated cardiomyopathy. Although FMR with mitral leaflet tethering can be improved by secondary chordal cutting, the technique may compromise valvular-ventricular interaction. The aim of chordal translocation (CT) is to maintain valvular-ventricular interaction. METHODS: An initial successful mitral valve repair with CT was performed on a 55-year-old patient with FMR. Following secondary chordal cutting, artificial chordae were sutured to the tip of each papillary muscle, from where the secondary chordae originated. The artificial chordae were passed through the mid-septal annulus and fixed on the side of the left atrium. The force direction generated by the artificial chordae was very similar to the natural stress line on the anterior mitral leaflet. In a subsequent clinical series, CT was performed on 13 FMR patients. RESULTS AND CONCLUSION: The study results indicated that CT, in conjunction with secondary chordal cutting, might represent a promising treatment for preserving valvular-ventricular interaction in FMR patients.