EARLY RESULTS OF POSTERIOR LEAFLET FOLDING PLASTY FOR MITRAL-VALVE RECONSTRUCTION

Background. Standard reconstruction for posterior mitral leaflet (PML) disease is quadrangular resection and annular plication; when the PML is excessively high, a sliding plasty is used. We have developed an a lternative technique, a posterior leaflet folding plasty. It is perfor med by folding down the cut vertical edges of the PML. The central hei ght of the PML is reduced, leaflet coaptation is moved posteriorly, an d annular plication is unnecessary. Methods. From March 1995 to August 1996, 26 (17.9%) of 145 patients undergoing mitral reconstruction had a posterior leaflet folding plasty. Concomitant procedures included a nterior leaflet resection or resuspension and myotomy and myectomy. in 3 patients, the PML resection extended to a commissure. Results. Ther e was one death and no reoperations. The mean New York Heart Associati on class was improved from 2.4 preoperatively to 1.4. There was no maj or postoperative mitral insufficiency in the 26 patients. Systolic ant erior motion was transiently seen in 1 patient in whom left ventricula r outflow tract obstruction was present preoperatively. Conclusions. T he data demonstrate the safety and short-term efficacy of posterior le aflet folding plasty. This technique may help avoid systolic anterior motion after reconstruction of the PML. (C) 1998 by The Society of Tho racic Surgeons.