Reconstruction of the Mitral Valve with Autologous Tissue

uring the past seven years a collaborative program directed at development of a technique or techniques for the reconstrucD tion of the diseased mitral valve with the patient’s own tissues has been in progress at St. Barnabas Hospital, Bronx, N.Y. This program has comprised fundamental investigations of the anatomy of the “fibrous skeleton” of the heart and the structure of the cardiac valves [33-37], long-term studies of the fate of various types of autogenous tissue utilized as free grafts in experimental reconstruction of the heart valves, development of a new type of oxygenator more suitable for the somewhat more prolonged periods of extracorporeal bypass that may be required [18, 22, 231, and trial of various surgical reparative techniques, at first in animals, later in human patients. The surgical approaches have passed through several developmental phases, gradually evolving into a number of highly reliable techniques that appear specifically and variably to be indicated, depending upon certain anatomical and pathological considerations in the individual clinical case. In a very real sense this work has been the logical continuation of the earliest surgical efforts at valvulotomy, valvuloplasty, valvotomy, and commissurotomy [l, 2, 9, 11, 12, 19, 20, 29, 311, subsequently modified to the term neostrophingic mobilization [3,4,6-81, and early efforts at patching perforations of the mitral valve and elongation of the shrunken mural leaflet [lo, 16, 17, 301.