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Back to 2014 Annual Meeting Abstracts

Plication Plasty for Reducing Posterior Mitral Leaflet Height
Aram K. Smolinsky1, Danny Spiegelstein2, Ory Vatury, MD3.
1Assuta Medical Center, Tel Aviv, Israel, 2Sheba Medical Center, Israel and Tel- Aviv University, Israel, 3The Sackler Medical School, Sheba MC, Israel.

Background: Excessive posterior mitral leaflet height is treated conventionally with sliding repair or folding plasty, both of which are irreversibly mutilating to the posterior leaflet. The plication plasty we introduce here is a non resection and reversible method. Method: Square pledgeted everting mattress sutures are employed along the rim of the P2 segment of the posterior leaflet, marked by the small commisures on its sides. Each stitch is commenced 2-3mm away from the leaflet/ atrial wall border, in the atrial side. The needle points into the LV, penetrates back up through the posterior mitral leaflet ~ 10mm away from the rim, and later through the annuloplasty device. Once tied down, the mitral leaflet between the rim and the site of emergence of the needle will fold and be plicated between the pledget and the annuloplasty device. This fold at the base of P2 will reduce its height just as desired. The farther one aims the needle, the wider the plication. Excellent anchorage of the ring to the posterior mitral annulus is a welcomed adjuvant. Results: This technique reduces the leaflet height in a controlled and reversible manner and strengthens the device anchorage at the posterior part of the mitral annulus. Near normal anatomy of the valve is maintained, both by operative appearance and the post-op TEE. The issue of post-repair SAM nearly vanished. Excellent anchorage of the area of the weakest ring tissue, at the base of P2, abolished the rare but troublesome cases of posterior ring dehiscence. Conclusion: Though insultingly simple, this approach for reducing posterior leaflet height provides efficient solutions for this issue, while strengthening posterior ring device anchorage as well.

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