TRANSPOSITION OF CHORDAE IN MITRAL-VALVE REPAIR - MIDTERM RESULTS

Background. Prolapse of the anterior mitral leaflet, unlike a posterio r prolapse, is a difficult lesion to repair. Leaflet plication and tri angular resection are satisfactory techniques only in case of a limite d prolapse. Chordal replacement has also been proposed but uses foreig n material. The purpose of this report is to assess the results of tra nsposition of chordae for the correction of mitral regurgitation (MR) caused by anterior leaflet prolapse. Methods and Results. Between Janu ary 1986 and December 1990, 44 adult patients with MR caused by anteri or leaflet prolapse underwent repair with transposition of chordae as one of the techniques. This population was retrospectively studied to assess the early and late results of this procedure. Chordae were tran sferred from the posterior to the anterior leaflet (n=25) or from an i ntermediary to a free edge position on the anterior leaflet (n=21) (tw o patients underwent both procedures). Two patients died (4.5%). None required early reoperation. Follow-up was complete and ranged from 18 to 82 months (mean, 40.2+/-19 months). No patient died during follow-u p. Two patients were reoperated on 6 and 8 months after surgery for re current MR unrelated to chordal transfer disruption. Doppler echocardi ographic studies were available in 95% of the cases at latest follow-u p and showed no or minimal MR (0 to 1/4) in 87.5% of the patients and mild MR (2/4) in 12.5%. Conclusions. Transposition of chordae appeared to be a simple and safe procedure for correction of anterior mitral p rolapse. Transposition of chordae allowed extension of the indications of valve repair. A longer follow-up will be necessary to draw firm co nclusions, but mid-term results are encouraging.