Atlas of Mitral Valve Repair, 1st Edition

10

Commissural Repair Techniques

COMMISSUROPLASTY WITH PERICARDIUM

Lai and Chard describe a commissuroplasty for a defect caused by extensive debridement of the leaflet and annulus (Fig. 10.1) (1).

 

Figure 10.1 Commissuroplasty. A: Vegetation and abscess located in the posteromedial commissure of the mitral valve. B: Radical debridement of the infected annulus and adjacent leaflets resulted in a large defect in the mitral valve orifice. The annular defect was patched with pericardium. C: The leaflet remnants were approximated at the leading edge with a horizontal mattress suture to form a zone of apposition (inset). The residual D-shaped defect between the mitral annular patch and apposed leaflets was closed with a pericardial patch, thus restoring valve competence. (From Lai DT, Chard RB. Commissuroplasty: a method of valve repair for mitral and tricuspid endocarditis. Ann Thorac Surg. 1999;68:1727-1730.)

P.54

SLIDING LEAFLET PLASTY OR PARACOMMISURAL SLIDING PLASTY

Figures 10.2 and 10.3 show the application of the sliding plasty technique for commissural prolapse used by van Herwerden et al. (2).

 

Figure 10.2 A: Incisions; dark area is resected. B: Completed repair. (From van Herwerden LA, Taams MA, Bos E. Repair of commissural prolapse by extended leaflet sliding.Ann Thorac Surg. 1994;57:387-390.)

 

Figure 10.3 Rotation paracommissural sliding plasty. (From Ng CK, Punzengruber C, Pachinger O, et al. Valve repair in mitral regurgitation complicated by severe annulus calcification. Ann Thorac Surg. 2000;70:53-58.)

P.55

 

Figure 10.4 Paracommissural edge-to-edge repair. (From Maisano F, Torracca L, Oppizzi M, et al. The edge-to-edge technique: a simplified method to correct mitral insufficiency. Eur J Cardiothorac Surg. 1998;13:240-245.)

 

Figure 10.5 Medial commissuroplasty. (Clip 6, Case 4) 

PARACOMMISSURAL EDGE-TO-EDGE REPAIR (COMMISSUROPLASTY)

A paracommissural edge-to-edge repair is a simpler procedure than sliding commissuroplasty for treating prolapse at one commissure. This can be performed with a figure-of-eight suture or a pledgeted or plain mattress suture (Fig. 10.4). This approach is quick and reliable and does not create stenosis (Fig. 10.5).

REFERENCES

  1. Lai DT, Chard RB. Commissuroplasty: a method of valve repair for mitral and tricuspid endocarditis. Ann Thorac Surg.1999;68:1727-1730.
  2. van Herwerden LA, Taams MA, Bos E. Repair of commissural prolapse by extended leaflet sliding. Ann Thorac Surg.1994;57:387-390.