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The Journal of Thoracic and Cardiovascular Surgery, Vol 97, 98-103, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JM Revuelta, R Garcia-Rinaldi, L Gaite, F Val and F Garijo
Surgical repair of ruptured or elongated chordae tendineae of the mitral
valve is one of the most complex reconstructive techniques in cardiac
surgery. Various surgical procedures have been described to repair chordal
abnormalities of the anterior leaflet of the mitral valve with
unpredictable results. Mitral valve replacement is usually recommended in
that situation. This report describes a simple repair technique that we
have devised. We resected one or two marginal chordae of the anterior
leaflet of the mitral valve in 35 sheep and replaced them with a
double-armed, pledget-supported, expanded polytetrafluoroethylene suture.
The 30 surviving animals were studied hemodynamically and were electively
put to death 3, 6, 9, 18, and 24 months after the operation. Mitral
insufficiency did not develop in any of the sheep. All specimens had a
normal mitral valve without thrombosis. The polytetrafluoroethylene suture
remained pliable and was incorporated into the anterior leaflet and
papillary muscle. Scanning and transmission electron microscopy showed that
the suture was completely covered by a sheath of tissue with a collagen
structure remarkably similar to that of a native chorda. Calcification was
not detected in the new chordae. This reproducible and safe technique may
considerably simplify the difficult repair of chordal abnormalities.
ARTICLES
Generation of chordae tendineae with polytetrafluoroethylene stents. Results of mitral valve chordal replacement in sheep
Hospital Nacional Marques de Valdecilla, Universidad de Cantabria, Santander, Spain.
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