A report on the successful sparing of the entire anterior mitral leaflet through the implementation of a customized procedure in the context of mitral valve replacement

Figures

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  Fig. 1. The illustration depicts the FCR-MVRpl. (A, B) The AML with a preserved chordal apparatus (illustrated with a yellow arrow) is incised across the entire anterior annulus from the posterior commissure (PC) to the anterior commissure (AC). Subsequently, the AML is repositioned and reattached to the posterior leaflet and annulus at the appropriate location (C). The stented bioprosthesis is then inserted (D). (E) The subvalvular apparatus is entirely retained without the presence of redundant tissue in the LV chamber. In cases of leaflet tissue redundancy resulting from Barlow disease, the surgical excision of an ellipse-shaped portion of the tissue along the length of the free edge leaflets at the A2 level and the level of the junction between A2/A1 and A2/A3 is imperative (Fig. 2A). This methodical approach ensures the excision of a 5- to 10-millimeter leaflet-free edge with only 3/4 basal chordae tendineae (Fig. 2A, B), while preserving the structural integrity of the left ventricle’s anatomical composition. FCR-MVRpl, full chordal rescue mitral valve replacement ; PML, posterior mitral leaflet; AML, anterior mitral leaflet; LV, left ventricular

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  Fig. 2. The biomechanical and morphological characteristics of the mitral valve and subvalvular apparatus are delineated. (A, B) In instances of tissue excess, as observed in Barlow disease, excision of a portion in the form of an ellipse may be indicated (red area), corresponding to A2 scallops and junction area A1/A2 and A2/A3 scallops with related basal chords, respectively. (B) The color illustration delineates the residual logarithmic strains in the collagen direction at the onset of systole, prior to ventricular pressure application on the leaflets

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  Fig. 3. Transthoracic echocardiography evaluation for decision tree in assessing severity of functional and degenerative mitral valve regurgitation. # see Table 1; * see Table 1

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  Fig. 4. The flowchart. Abbreviations: CCF, chronic cardiac failure; FCR-MVRpl, full chordal-rescue mitral valve replacement ; MV, mitral valve ; PCR-MVRpl, partial chordal rescue mitral valve replacement, AML, Anterior Mitral Leaflet

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  Fig. 5. Kaplan–Meier curves for freedom from procedural-related complications after FCR-MVRpl at 1 year

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  Fig. 6. Kaplan–Meier curves for freedom from death after FCR-MVRpl at 1 year

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  Fig. 7. New York Heart Association (NYHA) functional class modifications. Changes are depicted according to the aetiology of mitral regurgitation at baseline and 1 year after FCR-MVRpl

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  Fig. 8. Kaplan–Meier curves for freedom from treatment failure after FCR-MVRpl at 1 year