MITRAL-VALVE REMODELING USING AUTOLOGOUS PERICARDIUM - AN EXPERIMENTAL-STUDY

The aim of this study was to assess in vivo the efficacy of a new tech nique for remodeling the mitral valve. In 6 dogs during cardiopulmonar y bypass and cardioplegic cardiac arrest, both mitral valve leaflets w ere totally separated from the mitral ring and resected subtotally, le aving intact their narrow margins with insertion sites of the chordae tendineae of the first and second order. To mimic pathologic condition s, the chordae tendineae were then altered by placing two shortening s utures for every chordal stem. Based on standardized geometric calcula tions and using autologous pericardium treated with 0.62% glutaraldehy de solution, the new leaflets were then remodeled intraoperatively and sutured in place, merging them with the subvalvular apparatus and the native mitral ring. After restoration of stable circulatory condition s, valve function was evaluated under rest and defined loading conditi ons using a 5.0-MHz ultrasound transducer, applied epicardially. We fo und that intraoperative remodeling of the mitral valve leaflets using autologous pericardium with preservation of the subvalvular apparatus is possible and reproducible, and can be performed even when the subva lvular apparatus is altered morphologically. Functionally, the remodel ed valve proved to be satisfactory under conditions of rest and stress . The benefits conferred by autologous tissue, the reproducibility of the surgical technique, the good functionality of the remodeled valve, and the preservation of the subvalvular apparatus could make this tec hnique a useful surgical alternative for extensive mitral valve recons truction procedures in pediatric and adult patients.