Y. Kobayashi et al., MITRAL-VALVE DYSFUNCTION RESULTING FROM THICKENING AND STIFFENING OF ARTIFICIAL MITRAL-VALVE CHORDAE, Circulation, 94(9), 1996, pp. 129-132
Background There is little information about changes in mitral valve f
unction caused by thickening and stiffening of artificial chordae duri
ng follow-up. Using serial echocardiographic examination, we evaluated
thickening and stiffening of artificial chordae and the effect of tho
se changes on mitral valve function. Methods and Results Between Novem
ber 1986 and November 1993, 40 patients underwent mitral valve repair
with artificial chordae using glutaraldehyde-tanned xenograft pericard
ium (GTXP) or polytetrafluoroethylene suture (PTFE). Seven GTXP patien
ts and 20 PTFE patients underwent serial echocardiographic examination
after surgery and were included in the final analysis. Thickening and
stiffening of the artificial chordae were classified according to ech
ocardiographic changes after surgery: grade 1, no change; grade 2, thi
ckening and/or stiffening without impairment of the motion of the mitr
al valve leaflet; and grade 3, thickening and stiffening that impaired
motion of the mitral valve leaflet. The mean follow-ups in patients w
ith GTXP and PTFE were 6.0 and 3.6 years, respectively. During follow-
up, there were 2 GTXP patients with grade 2 thickening and stiffening
and 4 patients with grade 3. There were 6 PTFE patients with grade 2 t
hickening and stiffening and 2 patients with grade 3. Grade 3 occurred
earlier in GTXP than in PTFE patients (P<.05). Mitral valve area in G
TXP patients decreased from 2.5+/-0.4 to 2.1+/-0.3 cm(2) (P<.05); howe
ver, mitral valve area in PTFE patients showed no significant change d
uring follow-up (2.1+/-0.4 to 2.0+/-0.4 cm(2), P=NS). Conclusions Alth
ough mitral valve repair with artificial chordae is useful, more atten
tion should be paid to mitral valve function resulting from thickening
and stiffening of artificial chordae.