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Conservative surgical management provides an alternative to valve replacement for mitral insufficiency.
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This paper describes alternative conservative surgical techniques and prostheses for the management of mitral insufficiency due to chordal elongation or rupture, aiming to avoid valve replacement.
Mitral valve insufficiency is frequently the result of elongated or ruptured chordae tendineae. Several techniques have been described for its correction. However, when there is a severe elongation or rupture of the chordae, the most widely accepted treatment option has been valve replacement. The best long-term outcomes observed in conservative surgeries led us to choose this procedure rather than the correction of mitral valve insufficiency. We described three techniques for correction of mitral prolapse due to elongated and/or ruptured chordae tendineae. In addition, we developed mold pre built bovine pericardial chords (Braile-Gregori prosthesis) for chordae replacement. Finally, since 1987, the rigid prosthetic semicircular ring (Gregori-Braile ring) has been consistently used in our centre for correction of the posterior dilation of mitral annulus preferably in its portion close to the posteromedial commissure.
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Francisco Gregori (2012) conducted a review in Mitral insufficiency. Conservative surgical management (mitral valve repair techniques) was evaluated. Conservative surgical management of mitral insufficiency using techniques such as chordal shortening, partial tricuspid transfer, and the Gregori-Braile ring provides an alternative to valve replacement.
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