Echocardiographic Comparison of the Mitral Valve Morphology Between Leaflet Resection vs. Chordal Replacement

Objective: There are two different types of procedures to correct the prolapsed valve in the mitral valve plasty, but the impact of these procedures on the postoperative valve morphology has not been clearly determined. We conducted the echocardiographic study to compare the postoperative valve morphology between patients undergoing leaflet resection and chordal replacement. Methods: Among 36 patients undergoing mitral plasty for P2 lesion, the retrospective echocardiographic analysis could be made in 20 patients. The valve morphology was compared between 9 patients undergoing leaflet resection (LR group) and 11 patients undergoing chordal replacement (CR group). The leaflet motion of the affected valve was quantitatively evaluated with the angle between mitral annular plane and the leaflet at maximum open or closed position. Results: There were no differences in the maximum open angle (LR group: 53.5±15.3° vs. CR group: 65.5±11.6°, p=0.07) or the maximum closed angle (34.6±12.4° vs. 25.7±14.7°, p=0.15) between the two groups. The mobility of the leaflet was restricted at the semi closed position in most LR patients. On the other hand, the mobility was preserved in most CR patients, but was restricted at open position in three CR patients. The range of leaflet motion was significantly smaller in LR group than CR group (18.8±9.8° vs. 39.8±19.7°, p<0.01). Conclusions: Our echocardiographic results revealed that leaflet resection technique resulted in restricted leaflet motion at the semi-closed position. Chordal replacement technique may preserve the leaflet motion of the affected valves.