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Back to 2014 Annual Meeting Abstracts


New Predictive Method Of Resection Line In Mitral Valve Plasty With 3dtee.
Yasuko Miyaki, Tetsuya Higami, Kazutoshi Tachibana, Nobuyuki Takagi, Seiichi Funamoto.
Sapporo Medical university, Sapporo, Japan.

Objective: Mitral annuloplasty of the anterior mitral leaflet, is extremely difficult to perform. Currently, reconstruction with an artificial tendon without resection-suture technique is the most common method. However, it is useful for all cases. We developed an original surgical technique that can be used to easily perform mitral valvuloplasty for the anterior mitral leaflet, with a higher degree of completion. We named this technique ‘'Rough-zone Trimming Procedure'' and have applied it clinically. The Rough-zone Trimming Procedure involves only trimming of the rough-zone of the deviated surplus leaflet in a belt-like shape and suturing the resected edges back together. This technique is based on the concept of pulling the deviated leaflet edge to the left ventricle side and newly creating a deep coaptation area. Currently, eight years since developing the rough-zone trimming technique, long-term results for 50 cases have been extremely favorable and for Type 2 (Carpenter classification) MR, there have been no cases of re-surgery and no cases of moderate-severe MR after seven years. However, the length of the excision range of the rough zone used in this technique strongly depends on the surgeon's experience. We thought that with new method of us we could predict the rough zone excision range. Method: We used the recently developed iE33, X7-2 probe (Phillips Healthcare, Andover, MA) and QLAB quantification software (Phillips Healthcare). Resule: We measured preoperative and postoperative changes in the anterior leaflet free margin and annulus length before and after plication. Free margin length average was 121.6 cm (104.8-166.8) preoperatively and 87.4 cm (68.4-95.2) postoperatively. Annulus length average was 91.7 cm (55.6-111) preoperatively and 68.8 cm (37.4-68.6) postoperatively (n=14). This clarified the fact that preoperative leaflet free margin length reaches a fixed length postoperatively, regardless of annulus length. Results also indicated that when classified according to postoperative artificial valve size, the length of the completed leaflet corresponded to size (R2=0.683, p=0.006). Conclusion: We predict that performing resection so that the leaflet free margin length is of roughly the same size as the final annulus could aid in predicting excision range for this valvuloplasty technique.


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