MITRAL VALVULOPLASTY BY TRANSFER OF THE P OSTERIOR TRICUSPID LEAFLET AND ITS CHORDAE

Mitral valve repair was performed in six patients by transferring the posterior tricuspid leaflet with its sub-valvular apparatus onto the m itral valve. This new technique considers the tricuspid valve as the p atients own tissue bank where the posterior leaflet and eventually the adjacent part of the anterior leaflet is used as a ''donor'' valve, b ased on the knowledge that the right atrio-ventricular valve can be ef ficiently repaired with a very low risk of significant dysfunction. Th e mitral repair consists of incorporating the tricuspid autograft by s ecuring the tricuspid papillary muscle to the mitral papillary muscle and by suturing the leaflet tissue where required. A mitral annuloplas ty ring reinforces the repair. The tricuspid valve is subsequently rep aired by annular plication and leaflet suture. A tricuspid ring is nec essary to maintain efficient remodeling. The six patients ages ranged from 20 to 70 years. A etiology, was rheumatic in the first case and d egenerative in the following. In three cases, sterilised endocarditis was responsible for ruptured chordae and leaflet destruction. The mitr al insufficiency was located in a commissural area in 4 cases, and was due to a widespread posterior prolapse in 2. Post-operative control t ransesophageal echocardiography confirmed the excellent results of the repair and proved that, in selected cases, the tricuspid leaflet inse rted onto the mitral apparatus is very efficient in correcting mitral insufficiency, without causing significant tricuspid impairement. With a 3 to 7 month follow-up, the results are stable.