First in human neochordae retensioning for recurrence of mitral regurgitation after neochord procedure

Figures

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  Figure 1. Intraoperative transesophageal echocardiography. (A,B): before retensioning procedure 2D + color Doppler and 3D; eccentric regurgitation jet directed to AML and reprolapsing PML (arrow). (C,D): after retensioning procedure 2D + color Doppler and 3D: (C) central postprocedural mild MR (arrow) is showed. (D) Mild residual PML prolapse is highlighted (arrow) and a good coaptation between AML and PML is reached. AML, anterior mitral leaflet; MR, mitral regurgitation; PML, posterior mitral leaflet.

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  Figure 2. (A) Apex re-exposure through previous left mini-thoracotomy reopening: Identification of the chordal loops sprouting from the Teflon pledget (arrow) corresponding to the ventricular access site. (B) Samples sizing: temporary samples made of tourniquet tubing pieces (arrow) are positioned inside the loops, between the knots and the Teflon pledget. (C) Defining final samples: once the desired shape is set, the tourniquet pieces are fixed together with a 4-0 prolene suture and then covered with a Gore-Tex vascular prosthesis (arrow). (D) Samples fixation: definitely samples (arrows) are inserted inside the chordal loop and then fixed by suturing the vascular prosthesis to the corresponding loop with a 4-0 prolene suture.