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Готові списки джерел за темами / Mitral prolapse repair / Статті в журналах

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Статті в журналах з теми "Mitral prolapse repair"

Автор: Grafiati

Опубліковано: 11 березня 2023

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1

Hysi, Ilir, Laurence Gautier, Olivier Rebet, Ionut Carjaliu, Mihai Radutoiu, and Olivier Fabre. "Standardized loop technique for mitral valve repair offers good midterm results." Asian Cardiovascular and Thoracic Annals 28, no. 8 (July 28, 2020): 482–87. http://dx.doi.org/10.1177/0218492320947545.

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Background We reviewed the midterm results of our approach for mitral valve repair with the use of standardized loops. Methods In a retrospective single-center study, mitral repairs performed between November 2015 and December 2019 with the standardized loop technique were included. Predefined loops of 15 and 25 mm (Gore-Tex) were implanted for posterior or anterior mitral prolapses, respectively. Isolated or concomitant mitral repairs were performed by either a sternotomy or minithoracotomy. Mean follow-up was 25.3 ± 14.7 months. Results Among 92 patients operated on for mitral repair during this period, 65 had repair with the standardized loop technique. They were mostly men (73.8%) and the mean age was 65.1 ± 9.7 years. Valve prolapse was mainly posterior (87.7%), and cordal rupture was seen in 81.5% of cases. The procedures were carried out by a minithoracotomy in 49.2% of patients. Isolated mitral repairs represented 63.1% of cases. Crossclamp and bypass times were 102 ± 22.8 min and 144.7 ± 34.9 min, respectively. The mean number of loops implanted was 2.7 ± 0.9. No patient left the operating room with moderate or severe mitral regurgitation. Postoperative morbidity was 18.4% (12 patients) and 30-day mortality was 3.1% (2 patients). Overall 4-year survival and freedom from reoperation for mitral repair failure were 84.4% and 91.7%, respectively. Conclusions The standardized loop technique for mitral repair showed good midterm results. This technique can be valuable in the armamentarium of mitral repairs. Further evaluation is needed for long-term follow-up.

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2

Nazarov, V. M., A. V. Afanasev, and I. I. Demin. "Mitral valve repair in Barlow disease." Patologiya krovoobrashcheniya i kardiokhirurgiya 18, no. 1 (October 10, 2015): 70. http://dx.doi.org/10.21688/1681-3472-2014-1-70-73.

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A mitral valve prolapse nowadays is the most common cause of mitral insufficiency in the western countries and is associated with high morbidity and mortality. In the last decades repairing the mitral valve has become the operation of choice for treatment of the mitral valve prolapse, thus enabling to improve the geometry and function of the left ventricle and long-term survival. Literature related to mitral valve repair in patients with Barlow disease is reviewed.

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3

Verma, Subodh, and Thierry G. Mesana. "Mitral-Valve Repair for Mitral-Valve Prolapse." New England Journal of Medicine 361, no. 23 (December 3, 2009): 2261–69. http://dx.doi.org/10.1056/nejmct0806111.

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4

Bouzas-Mosquera, Alberto, Nemesio Alvarez-Garcia, and Jesus Peteiro. "Repair of Mitral-Valve Prolapse." New England Journal of Medicine 362, no. 9 (March 4, 2010): 857. http://dx.doi.org/10.1056/nejmc0912882.

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5

Stojanovic, Ivan, Marko Kaitovic, Aleksandra Novakovic, and Petar Vukovic. "Reconstructive surgery of an extremely calcified mitral valve in Barlow disease patient: A case report." Vojnosanitetski pregled 76, no. 5 (2019): 552–54. http://dx.doi.org/10.2298/vsp170312117s.

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Introduction: Mitral valve calcifications are frequent finding in the Barlow disease. This is makinkg mitral repair surgery even more demanding in already complex valve pathology. Case report: Fifty-five year old Barlow disease patient underwent mitral repair surgery due to posterior leaflet prolapse at P2 level and extensive posterior leaflet and annular calcifications as well. Prolapsed scalop was resected, while P1 and P3 scalops were detached from the annulus. After complete posterior annulus decalcification, so formedlarge atrio-ventricular defect was reconstructed with autologous pericardial patch and double suture line technique.P1 and P3 segments were reatched thereafter by sliding technique, and sutured with no strain. Annuloplasty was performed with saddle rigid ring No 36. Patient was discharged nine days after the surgery with just a trace of mitral reguritation. Conclusion: Annular decalcificaion and reconstruction in patients with calcified Barlow mitral disease is neccessary for safe and durable mitral valve repair surgery.

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6

Asai, Tohru. "Butterfly technique in mitral valve repair." Asian Cardiovascular and Thoracic Annals 28, no. 7 (April 6, 2020): 413–15. http://dx.doi.org/10.1177/0218492320916298.

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Degenerative mitral regurgitation due to posterior leaflet prolapse is often associated with tissue redundancy in the leaflet height and free margin of the prolapsing segment. The butterfly technique has been introduced for focal resection to precisely control the leaflet height without annular plication. This technique is indicated for a high prolapsing leaflet, greater than 20 mm. With intraoperative measurement of leaflet heights and ink dot marking as a depth indicator, the butterfly technique can be safely performed in most high posterior leaflet prolapse cases, without increasing the risk of systolic anterior motion.

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7

NISHIMURA, Yosuke. "Mitral Valve Repair for Patients with Mitral Valve Prolapse." Journal of UOEH 37, no. 3 (September 1, 2015): 195–202. http://dx.doi.org/10.7888/juoeh.37.195.

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8

Panicker, Varghese, Renjith Sreekantan, and Sai Suraj Kotera. "Taming of the Tiger: A Novel Technique to Deal With Mitral Annular Calcification —A Case Series." Heart Surgery Forum 23, no. 6 (October 20, 2020): E793—E796. http://dx.doi.org/10.1532/hsf.3223.

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Background: Mitral valve surgery can be challenging for patients with mitral annular calcification (MAC). The prevalence of MAC in patients who undergo mitral valve replacement is 19.9%. The treatment options for MAC include complete decalcification and annular reconstruction with valve repair/replacement or performing a surgical valve repair or replacement without decalcification, accepting the risk of paravalvular leak. We describe three cases of mitral valve prolapse with posterior annular calcification, which were repaired using a unique technique that does not require decalcification. Case reports: The mitral annular calcification was heavy and involved most of the posterior annulus just sparing the commissures in all the three cases. Leaflet prolapse was dealt with by using neochordae, closing any clefts, and leaflet plication. Since the MAC ring was not complete and there was chance of further dilatation of the annulus, a partial annuloplasty was done using a PTFE felt (cut as strip). There was trivial to no mitral regurgitation with this technique in the immediate postoperative and five-year follow-up period echocardiography in all the three cases. Conclusion: This technique can benefit the major subset of pure mitral valve regurgitant lesions associated with MAC, which is limited to the posterior annulus.

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9

Morimoto, Hironobu, Koji Tsuchiya, Masato Nakajima, Okihiko Akashi, and Kaori Kato. "Mitral Valve Repair for Extended Commissural Prolapse Involving Complex Prolapse." Asian Cardiovascular and Thoracic Annals 15, no. 3 (June 2007): 210–13. http://dx.doi.org/10.1177/021849230701500307.

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10

Rodriguez, Evelio, Michael W. A. Chu, John Narron, Karen Gersch, L. Wiley Nifong, and W. Randolph Chitwood. "Robotic Mitral Valve Repairs Requiring Reoperations." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 3, no. 1 (January 2008): 12–15. http://dx.doi.org/10.1097/01.imi.0000302172.43259.3d.

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Objective Robotic mitral valve (MV) repairs are performed at many institutions. Repair failures have been attributed to the challenging technology and potentially to the use of annuloplasty band anchoring U-clips. The purpose of this study was to characterize causes of robotic MV repair failure. Methods A total of 300 patients underwent a da Vinci robotic MV repair between May 2000 and November 2006 by a single operating console surgeon. Standard repair techniques and a Cosgrove annuloplasty band were used in every case. Clinical data in patients requiring a reoperation, as well as videos of their original operation, were reviewed. MV pathology, repair methods, and findings at reoperation were determined. Results Sixteen (5.3%) patients required reoperation. Seven (7%) failures occurred in the first 100 cases and 9 (4.5%) in the last 200 cases. Initial MV pathology included isolated anterior (n = 4) or posterior leaflet prolapse (n = 6), bileaflet prolapse (n = 3), and annular dilation (n = 3). Reoperations after their initial operation were required early (<6 months) in 8 patients and later in 8 patients. Reasons for reoperation included CHF (n = 9), hemolysis (n = 4), systolic anterior leaflet motion (n = 2), and endocarditis (n = 1). At reoperation, 7 patients had partial dehiscence of the annuloplasty band. The incidence of band dehiscence was not associated with the use of U-clips and decreased with experience. Conclusions Reoperative rates seemed to decrease with increased case volume and surgeon's experience. Repair results using robotic techniques are similar to conventional techniques. The use of U-clips is not associated with a higher reoperation rate.

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11

Olsthoorn, Jules R., Samuel Heuts, Jean Daemen, Jos Maessen, and Peyman Sardari Nia. "Mitral valve repair for posterior leaflet prolapse." ASVIDE 6 (June 2019): 179. http://dx.doi.org/10.21037/asvide.2019.179.

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12

Pfannmüller, Bettina, Jörg Seeburger, Piroze Davierwala, and Friedrich W. Mohr. "Repair of the anterior mitral leaflet prolapse." Expert Review of Medical Devices 11, no. 1 (December 2, 2013): 89–100. http://dx.doi.org/10.1586/17434440.2014.862034.

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13

Yurekli, Ismail, Mert Kestelli, Habib Cakir, and Hasan Iner. "About Commissural Prolapse and Mitral Valve Repair." Annals of Thoracic Surgery 104, no. 2 (August 2017): 718. http://dx.doi.org/10.1016/j.athoracsur.2016.10.059.

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14

Strazdins, Uldis, Gvido Janis Bergs, Martins Kalejs, and Indra Vilumsone. "Transapical Off-Pump Neochord Implantation in Case of Severe Mitral Regurgitation." Acta Chirurgica Latviensis 16, no. 2 (December 1, 2016): 28–30. http://dx.doi.org/10.1515/chilat-2017-0007.

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SummaryMitral regurgitation is common valvular heart disease and a major cause of congestive heart failure and death. It is most often associated with degenerative changes in mitral valve which leads to valve prolapse. Transapical off-pump mitral valve repair is a new minimally invasive procedure to treat mitral regurgitation. Here we report 64-year old female who suffered from grade III mitral regurgitation due to ruptured chorda and posterior leaflet P2/P3 segment prolapse. During surgery 4 artificial chordae were implanted and postoperative echocardiography results showed minimal residual grade I mitral regurgitation, therefore significant clinical improvement can be achieved with minimally invasive approach.

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15

Sathananthan, J., P. Raudkivi, and Andrew Kerr. "Mitral Valve Repair for Mitral Valve Prolapse: The Auckland Experience." Heart, Lung and Circulation 22, no. 7 (July 2013): 578. http://dx.doi.org/10.1016/j.hlc.2013.04.072.

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16

Sathananthan, J., P. Raudkivi, and A. Kerr. "Mitral Valve Repair for Mitral Valve Prolapse: The Auckland Experience." Heart, Lung and Circulation 22 (January 2013): S238. http://dx.doi.org/10.1016/j.hlc.2013.05.566.

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17

Gu, Xiaoyan, Yihua He, Zhian Li, Jiancheng Han, Jian Chen, and J. V. (Ian) Nixon. "Echocardiographic versus Histologic Findings in Marfan Syndrome." Texas Heart Institute Journal 42, no. 1 (February 1, 2015): 30–34. http://dx.doi.org/10.14503/thij-13-3848.

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This retrospective study attempted to establish the prevalence of multiple-valve involvement in Marfan syndrome and to compare echocardiographic with histopathologic findings in Marfan patients undergoing valvular or aortic surgery. We reviewed echocardiograms of 73 Marfan patients who underwent cardiovascular surgery from January 2004 through October 2009. Tissue histology was available for comparison in 29 patients. Among the 73 patients, 66 underwent aortic valve replacement or the Bentall procedure. Histologic findings were available in 29 patients, all of whom had myxomatous degeneration. Of 63 patients with moderate or severe aortic regurgitation as determined by echocardiography, 4 had thickened aortic valves. The echocardiographic findings in 18 patients with mitral involvement included mitral prolapse in 15. Of 11 patients with moderate or severe mitral regurgitation as determined by echocardiography, 4 underwent mitral valve repair and 7 mitral valve replacement. Histologic findings among mitral valve replacement patients showed thickened valve tissue and myxomatous degeneration. Tricuspid involvement was seen echocardiographically in 8 patients, all of whom had tricuspid prolapse. Two patients had severe tricuspid regurgitation, and both underwent repair. Both mitral and tricuspid involvement were seen echocardiographically in 7 patients. Among the 73 patients undergoing cardiac surgery for Marfan syndrome, 66 had moderate or severe aortic regurgitation, although their valves manifested few histologic changes. Eighteen patients had mitral involvement (moderate or severe mitral regurgitation, prolapse, or both), and 8 had tricuspid involvement. Mitral valves were most frequently found to have histologic changes, but the tricuspid valve was invariably involved.

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18

Ikenaga, Hiroki, Moody Makar, Florian Rader, Robert J. Siegel, Saibal Kar, Raj R. Makkar, and Takahiro Shiota. "Mechanisms of mitral regurgitation after percutaneous mitral valve repair with the MitraClip." European Heart Journal - Cardiovascular Imaging 21, no. 10 (October 12, 2019): 1131–43. http://dx.doi.org/10.1093/ehjci/jez247.

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Abstract Aims We sought to find the morphological mechanisms of recurrent mitral regurgitation (MR) after MitraClip procedure using 3D transoesophageal echocardiography (TOE). Methods and results Of 478 consecutive patients treated with the initial MitraClip procedure, 41 patients who underwent repeat mitral valve (MV) transcatheter or surgical intervention for recurrent MR were retrospectively reviewed. Using 3D-TOE, we investigated morphological changes of MV leading to repeat MV intervention. Aetiology of MR at the index intervention was primary in 24 (59%) and secondary in 17 (41%) patients. In the primary MR group, worsening leaflet prolapse at the clip site caused recurrent MR in 12 (50%) patients, while 7 (29%) patients had a leaflet tear at the clip site. Acute single leaflet device detachment was seen in four patients and one patient had recurrent MR between the plug and the clip. In secondary MR, left ventricular (LV)/left atrial dilation caused recurrent MR in 13 (76%) patients. Significant increase in the LV end-diastolic volume and tenting height were observed from post-index procedure to repeat intervention (LV end-diastolic volume; from 205 to 237 ml, P < 0.001, tenting height; from 0.8 to 1.3 cm, P < 0.001). New emergent leaflet prolapse/flail was seen in 3 (18%) patients, suggesting iatrogenic MR. Conclusion Mechanisms of recurrent MR after MitraClip procedure varied and depended on the underlying MV pathology: in primary MR, worsening mitral leaflet prolapse and in secondary MR, progressive LV dilation with worsening tenting were the main causes of recurrent MR.

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19

Van Praet, Karel M., Markus Kofler, Stephan Jacobs, Volkmar Falk, Axel Unbehaun, and Jörg Kempfert. "The MANTA Vascular Closure Device for Percutaneous Femoral Vessel Cannulation in Minimally Invasive Surgical Mitral Valve Repair." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 15, no. 6 (September 29, 2020): 568–71. http://dx.doi.org/10.1177/1556984520956300.

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A 65-year-old Caucasian male was referred to our institution with severe mitral regurgitation due to posterior mitral leaflet prolapse. The patient underwent minimally invasive surgical mitral valve repair. Here we present the application of a new vascular closure device (MANTA) for percutaneous arterial access and closure.

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20

Tanaka, Chiharu, Kazumi Akasaka, Ryohei Ushioda, Tomoki Nakatsu, Naohiro Wakabayashi, Hayato Ise, Hiroto Kitahara, Sentaro Nakanishi, Natsuya Ishikawa, and Hiroyuki Kamiya. "Examination of Anterior Leaflet Pseudoprolapse Causing Severe Mitral Regurgitation and Its Ideal Surgical Procedure." Heart Surgery Forum 23, no. 2 (April 13, 2020): E205—E211. http://dx.doi.org/10.1532/hsf.2895.

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Background: The aim of this study is to evaluate severe mitral regurgitation caused by so called atrial leaflet “pseudoprolapse” and verify the effect of simple annular stabilization. Methods: One-hundred-twenty-two patients underwent surgery for severe mitral regurgitation at our institute between January 2015 to July 2018. Of those, 32 cases diagnosed as anterior leaflet prolapse that underwent mitral repair were analyzed. Ten cases with pseudoprolapse, which is defined as anterior leaflet prolapse without dropping into the left atrium beyond the annular line causing eccentric regurgitation flow directed to the posterior atrium, were classified as the Pseudoprolapse Group. The other 22 cases had obvious anterior leaflet prolapse dropping into the left atrium; these cases were classified as the True Prolapse Group. We compared clinical findings between the 2 groups and reviewed pseudoprolapse cases. Results: Patients in the Pseudoprolapse Group had lower ejection fraction and lower regurgitation volume than those in the True Prolapse Group. A2 lesion as main inflow of regurgitation was more included in the Pseudoprolapse Group. All but one patient in the Pseudoprolapse Group received only simple annuloplasty, and all patients in the True Prolapse Group received leaflet repair and annuloplasty. In both groups, mid-term regurgitation grade and the reoperation rate were satisfactory. In the Pseudoprolapse Group, 6 cases were clarified as atrial functional mitral regurgitation, and 4 cases were considered to have focal posterior leaflet tethering. Conclusions: Pseudoprolapse cases could be characterized by low ejection fraction, low regurgitation volume, and A2 prolapse. For most cases with pseudoprolapse, simple annuloplasty may be enough, however further study is needed.

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21

Chawla, Surendra K., Muralidhar Padala, W. Randolph Chitwood, and Robert W. M. Frater. "Use of a New Expanded Polytetrafluoroethylene Multichordal Mitral Apparatus (Mitrapatch) to Repair Complex Mitral Valve Lesions." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 12, no. 6 (November 2017): 411–17. http://dx.doi.org/10.1097/imi.0000000000000434.

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Objective We report a new expanded polytetrafluoroethylene multichordal mitral apparatus (MitraPatch) to simplify mitral repairs involving multiple cusps and sought to describe the surgical technique and demonstrate the efficacy of the device. Methods MitraPatch was laser cut from a single sheet of expanded polytetrafluoroethylene and mounted on a custom-designed handle. Surgical technique to deploy the apparatus on the native mitral valve was developed in ex vivo porcine hearts. Hemodynamic efficacy of repairing mitral prolapse and regurgitation was assessed in ex vivo hearts and in five 30-day chronic swine, with histopathology in an additional swine at 120 days after implantation. Results In ex vivo heart studies, leaflet coaptation was restored from 0 mm at the posterior prolapsing segment to 8.1 ± 2.2 mm after repair with the MitraPatch ( P < 0.05) and to 10.2 ± 1.3 mm after the repair of the anterior leaflet ( P < 0.05). In in vivo studies, valve function at 30 days was considered good, with none to trace regurgitation. Device was flexible, without tissue overgrowth or dehiscence. At 120 days, complete endothelialization was observed. Conclusions The multichordal MitraPatch can potentially simplify complex mitral valve repairs involving multiple leaflet cusps, possibly enabling an optimal mitral repair even by surgeons without the focused high-volume experience.

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22

Brunsting, Louis A., J. Scott Rankin, Kimberly C. Braly, and Robert S. Binford. "Robotic Artificial Chordal Replacement for Repair of Mitral Valve Prolapse." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 4, no. 4 (July 2009): 229–32. http://dx.doi.org/10.1097/imi.0b013e3181b0aa5d.

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Artificial chordal replacement (ACR) has emerged as a superior method of mitral valve repair with excellent early and late efficacy. It is also ideal to combine with robotic techniques for correction of mitral prolapse, and this article presents a current method of robotic Gore-Tex ACR. Patients with isolated posterior leaflet prolapse are approached with the fourth-generation DaVinci robotic system and endoaortic balloon occlusion. A pledgetted anchor stitch is placed in a papillary muscle, and a 2-o Gore-Tex suture is passed through the anchor pledget. After full annuloplasty ring placement, the Gore-Tex suture is woven into the prolapsing segment and positioned temporarily with robotic forceps. Chordal length is then “adjusted” by lengthening or shortening the temporary knot over 1-cm increments as the valve is tested by injection of cold saline into the ventricle. After achieving good leaflet position and valve competence, the chord is tied permanently. The “adjustable” ACR procedure preserves leaflet surface area and produces a competent valve in the majority of patients. Postoperative transesophageal echo shows a large surface area of coaptation. Patient recovery is facilitated by the minimally invasive approach, while long-term stability of similar open ACR techniques have been excellent with a 2% to 3% failure rate over 10 years of follow-up. Robotic Gore-Tex ACR without leaflet resection is a reproducible procedure that simplifies mitral repair for prolapse. The outcomes observed in early robotic applications have been excellent. It is suggested that most patients with simple prolapse might validly be approached in this manner.

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23

Pitsis, Antonios, Nikolaos Tsotsolis, Efstratios Theofilogiannakos, Harisios Boudoulas, and Konstantinos Dean Boudoulas. "Preoperative determination of artificial chordae tendineae length by transoesophageal echocardiography in totally endoscopic mitral valve repair." Interactive CardioVascular and Thoracic Surgery 31, no. 1 (April 1, 2020): 20–27. http://dx.doi.org/10.1093/icvts/ivaa046.

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Abstract OBJECTIVES Artificial chordae tendineae are widely used for surgical repair in patients with mitral regurgitation due to floppy mitral valve/mitral valve prolapse. Expanded polytetrafluoroethylene has been used to construct these artificial chordae; however, the determination of the optimal length of the chordae prior to surgery has been an issue. For this reason, such a method was developed and the results of its use are presented. METHODS Forty-seven consecutive patients with significant mitral regurgitation due to floppy mitral valve/mitral valve prolapse who underwent totally endoscopic mitral valve surgery were studied. The chordae length was predetermined using transoesophageal echocardiography. The length between the top of the fibrous body of the papillary muscle and the coaptation line of the 2 leaflets of the mitral valve was measured and used to define the length of the chordae to be used for repair. Then under stereoscopic vision, a total endoscopic mitral valve repair was performed. RESULTS The predicted mean length of chordal loops was 19.76 ± 0.71 mm (median 20, range 16–28) and the actual mean length of chordal loops used was 19.68 ± 0.74 mm (median 20, range 16–26) demonstrating an excellent correlation between the two (r = 0.959). The mean number of chordae loops used per patient was 5.12 ± 0.62 (median 4, range 2–12). All patients at the time of discharge had no or trivial mitral regurgitation on transoesophageal echocardiography. CONCLUSIONS The chordae length used for mitral valve repair can be determined prior to surgery using transoesophageal echocardiography with a high degree of accuracy. Further, total endoscopic repair in this group of patients provides excellent results. For these reasons, it is expected that this method will replace most traditional approaches to cardiac surgeries in the years to come.

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24

Okada, Yukikatsu, Michihiro Nasu, Tadaaki Koyama, Yu Shomura, Mituru Yuzaki, Takashi Murashita, Naoto Fukunaga, and Yasunobu Konishi. "Outcomes of mitral valve repair for bileaflet prolapse." Journal of Thoracic and Cardiovascular Surgery 143, no. 4 (April 2012): S21—S23. http://dx.doi.org/10.1016/j.jtcvs.2011.11.014.

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25

Faerber, G., N. Zeynalov, H. Kirov, S. Tkebuchava, M. Diab, C. Sponholz, and T. Doenst. "Minimally Invasive Repair of Bileaflet Mitral Valve Prolapse." Thoracic and Cardiovascular Surgeon 66, S 01 (January 2018): S1—S110. http://dx.doi.org/10.1055/s-0038-1627902.

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26

Gillinov, A. Marc, Kevin G. Shortt, and Delos M. Cosgrove. "Commissural Closure for Repair of Mitral Commissural Prolapse." Annals of Thoracic Surgery 80, no. 3 (September 2005): 1135–36. http://dx.doi.org/10.1016/j.athoracsur.2004.04.051.

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27

Glower, Donald D., Bhargavi Desai, and G. Burkhard Mackensen. "Early Results of Edge-to-Edge Alfieri Mitral Repair via Right Mini-Thoracotomy in 68 Consecutive Patients." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 4, no. 5 (September 2009): 256–60. http://dx.doi.org/10.1097/imi.0b013e3181bba05e.

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Objective To examine early outcomes of mitral valve repair using Alfieri repair via a right mini-thoracotomy approach. Methods Records were examined in 68 consecutive patients undergoing Alfieri mitral repair via 6 cm right mini-thoracotomy. Most repairs were performed under cardioplegic arrest, using percutaneous femoral cannulation and direct aortic cannulation through the right first intercostal space. All patients without hypertrophic cardiomyopathy received rigid ring annuloplasty. The indications for Alfieri repair were extensive prolapse with ring size at least 30 mm. Results Mean age was 56 ± 13 (range, 20–80). Mitral disease etiology was Barlow disease in 17 of 68 (25%) patients and myxomatous disease in 47 of 68 (69%). Concurrent procedures were performed in 29 of 68 (43%) patients. Median ring size was 34 mm. Despite extensive leaflet disease, 59 of 68 (87%) patients were repaired without leaflet resection. Chord pairs were inserted on the posterior leaflet in 18 of 68 (26%) patients and anterior leaflet in four patients. There were no 30-day or late deaths. Residual intraoperative mitral regurgitation was absent in 54 of 68 (79%) patients and trace in the remainder. Local echocardiography follow-up at a mean of 99 days showed median residual regurgitation to be trace. Only two patients developed moderate regurgitation. Mean mitral gradient at follow-up was 4 ± 2 mm Hg. Local follow-up showed 28 of 39 (72%) patients to be New York Heart Association class I. Conclusions An edge-to-edge Alfieri repair via mini-thoracotomy can provide excellent short-term results in selected patients with complex myxomatous mitral disease when minimizing the need for leaflet resection.

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Raman, Jai, Pallav Shah, Siven Seevanayagam, John Cheung, and Brian Buxton. "Mitral Regurgitation: Comparison between Edge-to-Edge Repair and Valve Replacement." Asian Cardiovascular and Thoracic Annals 11, no. 2 (June 2003): 131–34. http://dx.doi.org/10.1177/021849230301100209.

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Mitral regurgitation due to bileaflet prolapse and ischemic causes can be difficult to repair. Midterm experience of the Alfieri edge-to-edge repair as an alternative to valve replacement is reported. Twenty-six patients with severe mitral regurgitation underwent the Alfieri repair between January 1998 and December 2000 (group 1); 15 cases were due to bileaflet prolapse and 7 were of ischemic origin. During the same period, valve replacement was performed in 36 patients (group 2), 20 of whom had similar indications. Follow-up was complete to a mean of 15 months (range, 1–28 months). There was no early death in either group. During follow-up, there was no reoperation in group 1, while 2 patients in group 2 required reoperations due to prosthetic valve endocarditis. There were 4 major thromboembolic or bleeding events in group 2, and none in group 1. All patients in group 1 had trivial to mild mitral regurgitation on follow-up echocardiography. The mean mitral valve gradient was significantly higher in group 2 compared to group 1 (7.2 versus 3.2 mm Hg, p = 0.001). The edge-to-edge repair is associated with good early and midterm results. Long-term follow-up is required to evaluate the durability of this technique.

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Elwatidy, Ahmed M. "Novel Techniques in Mitral Repair Extended and Rotational Chordal Transfer." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 5, no. 1 (January 2010): 63–66. http://dx.doi.org/10.1097/imi.0b013e3181cbd334.

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Mitral valve repair is preferable to mitral valve replacement because of low rate of thromboembolism, resistance to endocarditis, excellent late durability, and no need for anticoagulation in the majority of patients. This article describes 2 novel techniques for repairing the anterior mitral leaflet prolapse. The extended chordal transfer is achieved by transferring an extended segment of posterior mitral leaflet and, rotational chordal transfer, by rotating the transferred segment either vertical or horizontal. Both techniques are simple and reproducible. It uses patient's own natural chorda and eliminates the problem of knotting and determination of appropriate chordal length faced with other techniques.

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Rankin, J. Scott, and Jeffrey G. Gaca. "Techniques of Aortic Valve Repair." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 6, no. 6 (November 2011): 348–54. http://dx.doi.org/10.1097/imi.0b013e31824641d7.

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Similar to mitral repair, newer methods of aortic valve reconstruction are achieving excellent outcomes with an 85% to 90% freedom from valve-related complications at 10 years. The goal of this review is to illustrate these newer and more stable techniques of aortic valve repair. Most patients with aortic insufficiency from either trileaflet or bicuspid aortic valves are candidates for repair, in addition to selected patients with mixed aortic stenosis/insufficiency and aortic root aneurysms. Initially, aggressive commissural annuloplasty is performed to reduce measured valve diameter to 19 to 21 mm. Leaflet prolapse is corrected with plication stitches placed in the free edge of each leaflet adjacent to the Nodulus Arantius. In this regard, the leaflet free edge functions as the chorda tendinea of the aortic valve, and shortening with plication stitches raises the leaflet to a proper “effective height.” Leaflet defects are augmented with gluteraldehyde-fixed autologous pericardium, and mild-to-moderate strategically placed spicules of calcium are removed with the cavitron ultrasonic surgical aspirator. Using these methods, most insufficient aortic valves, and many with mixed lesions, can be satisfactorily repaired. Six cases are illustrated in this review, spanning the spectrum of pathologies from annular dilatation without leaflet defects, to standard congenital bicuspid valve with prolapse, to trileaflet prolapse, to unusual bicuspid pathology with calcification, to a moderately calcified trileaflet valve with mixed lesions, and to aortic root aneurysms with severe aortic insufficiency. All valves were repaired using the techniques described above with trivial residual leak and minimal gradients. All repairs have been followed with yearly echocardiography, and valve reconstruction with these methods is now quite stable with excellent late outcomes. Most insufficient aortic valves now can undergo stable repair with minimal late valve-related complications. Greater application of aortic valve repair seems indicated.

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Uchimuro, Tomoya, Minoru Tabata, Kiyomi Saito, Kentaro Shibayama, Hiroyuki Watanabe, Toshihiro Fukui, Tomoki Shimokawa, Hitoshi Kasegawa, and Shuichiro Takanashi. "Post-repair coaptation length and durability of mitral valve repair for posterior mitral valve prolapse." General Thoracic and Cardiovascular Surgery 62, no. 4 (November 5, 2013): 221–27. http://dx.doi.org/10.1007/s11748-013-0341-2.

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Cohn, Lawrence H., Verdi J. DiSesa, Gregory S. Couper, Pamela S. Peigh, Wendy Kowalker, and John J. Collins. "Mitral valve repair for myxomatous degeneration and prolapse of the mitral valve." Journal of Thoracic and Cardiovascular Surgery 98, no. 5 (November 1989): 987–93. http://dx.doi.org/10.1016/s0022-5223(19)34283-7.

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Yoshikai, Masaru, Hiroyuki Ohnishi, Manabu Itoh, and Ryou Noguchi. "Mitral valve repair for broad, asymmetrical prolapse in the posterior mitral leaflet." General Thoracic and Cardiovascular Surgery 56, no. 3 (March 2008): 137–39. http://dx.doi.org/10.1007/s11748-007-0199-2.

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Hirotani, Takashi, Tadashi Kameda, Yaushi Kato, Shogo Shirota, and Hiroyoshi Fujiwara. "Repair of mitral regurgitation caused by prolapse of the anterior mitral leaflet." Japanese Journal of Thoracic and Cardiovascular Surgery 46, no. 9 (September 1998): 873–77. http://dx.doi.org/10.1007/bf03217836.

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Mohty, Dania, and Maurice Enriquez-Sarano. "The long-term outcome of mitral valve repair for mitral valve prolapse." Current Cardiology Reports 4, no. 2 (March 2002): 104–10. http://dx.doi.org/10.1007/s11886-002-0021-9.

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Da Col, Uberto, Simone Perticoni, and Enrico Ramoni. "Parannular Elliptical Posterior Resection: A Low-Impact Reparative Technique for Mitral Valve Prolapse." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 10, no. 4 (July 2015): 252–57. http://dx.doi.org/10.1097/imi.0000000000000181.

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Objective Although effective, Carpentier technique for mitral regurgitation presents two “Achille's heel”: the resection of the whole prolapsing section of posterior mitral leaflet (PML) including chordae tendinae and the annular distortion due to plication. An alternative technique of limited PML resection, which preserves mitral anatomy decreasing the impact on valve function, and 9-year outcome are presented. Methods Since April 2005 till March 2014, of 205 patients affected by mitral prolapse scheduled for repair (mitral valve repair), 54 patients have been included in the study. The rationale of the new technique was to limit PML resection to achieve a fair reduction of the prolapsing scallop(s) height, to avoid leaflet and annular distortion, and to spare the coaptation surface and other substantial structures. According to the observation that the posterior smooth zone of PML is quite free from chordal insertions, an elliptical slice of tissue was resected from this area. Annuloplasty and neochordal insertion when indicated completed the procedure. Results Up to 9 years of follow-up was 98% complete. One inhospital death, two late noncardiac deaths, one redo operation due to endocarditis were reported. On late follow-up, 92% patients were on New York Heart Association class I. Late echocardiography showed stability of repair (regurgitation grade of ≤1 in 92% of patients). Nearly two third of valves preserved good PML mobility. Conclusions The parannular elliptical posterior leaflet resection, providing excellent stable midterm results, seems to be a safe alternative method for repair of PML prolapse. It avoids distortion and weakening of annulus and leaflet, and it allows restoring a proper coaptation surface and maintains a satisfactory PML motion.

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Javadikasgari, Hoda, Rakesh M. Suri, Bassman Tappuni, Ashley M. Lowry, Tomislav Mihaljevic, Stephanie Mick, and A. Marc Gillinov. "Robotic mitral valve repair for degenerative posterior leaflet prolapse." Annals of Cardiothoracic Surgery 6, no. 1 (January 2017): 27–32. http://dx.doi.org/10.21037/acs.2017.01.07.

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Alfieri, Ottavio, Michele De Bonis, Elisabetta Lapenna, Tommaso Regesta, Francesco Maisano, Lucia Torracca, and Giovanni La Canna. "“Edge-to-edge” repair for anterior mitral leaflet prolapse." Seminars in Thoracic and Cardiovascular Surgery 16, no. 2 (June 2004): 182–87. http://dx.doi.org/10.1053/j.semtcvs.2004.03.002.

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Pfannmüller, Bettina, Joerg Seeburger, Martin Misfeld, Michael Andrew Borger, Jens Garbade, and Friedrich W. Mohr. "Minimally invasive mitral valve repair for anterior leaflet prolapse." Journal of Thoracic and Cardiovascular Surgery 146, no. 1 (July 2013): 109–13. http://dx.doi.org/10.1016/j.jtcvs.2012.06.044.

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Shimomura, Takeru, Masahiro Toyama, Ysushi Takagi, Akihiko Usui, and Yuichi Ueda. "Edge-to-edge technique to repair mitral commissural prolapse." Japanese Journal of Thoracic and Cardiovascular Surgery 54, no. 12 (December 11, 2006): 516–19. http://dx.doi.org/10.1007/s11748-006-0054-x.

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Bonaros, Nikolaos, Daniel Hoefer, Cenk Oezpeker, Can Gollmann-Tepeköylü, Johannes Holfeld, Julia Dumfarth, Juliane Kilo, et al. "Predictors of safety and success in minimally invasive surgery for degenerative mitral disease." European Journal of Cardio-Thoracic Surgery 61, no. 3 (November 5, 2021): 637–44. http://dx.doi.org/10.1093/ejcts/ezab438.

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Abstract OBJECTIVES The aim of this study was to identify predictors of periprocedural success and safety in minimally invasive mitral valve surgery and to determine the impact of pathology localization and repair technique on reoperation-free survival. METHODS We isolated 686 patients (mean age 60.5, standard deviation 12.3 years, 69.4% male) who underwent surgery for mitral valve prolapse between 2002 and 2020 in a single institution. Patients with concomitant disease, redo or mitral pathology other than degenerative mitral disease were excluded from the analysis. Periprocedural safety was defined as: freedom from perioperative death, myocardial infarction, stroke, use of extracorporeal membrane oxygenation or reoperation for bleeding. Operative success was defined as: successful primary mitral repair without conversion to replacement or to larger thoracic incisions, without residual mitral regurgitation > mild at discharge or reoperation within 30 days. Predictors for perioperative success and safety were identified using univariable and multivariable analyses. The impact of prolapse localization and repair technique on reoperation-free survival was assessed by Cox regression. RESULTS The mitral repair rate and the need for concomitant tricuspid repair were 94.6% and 16.5%, respectively. Perioperative mortality occurred in 5 patients (0.7%). The criteria for perioperative safety and success were met in 646/686 (94.2%) and 648/686 (94.5%) patients, respectively. The absence of tricuspid disease requiring repair was the only independent predictor of safety in this cohort [hazard ratio (HR) 0.460 (0.225–0.941), P = 0.033]. The only independent predictor of operative success was the use of chordal replacement [0.27 (0.09–0.83), P = 0.022]. Reoperation-free survival was 98.5%, 94.5% and 86.9% at 1, 5 and 10 years, respectively. Posterior leaflet pathology demonstrated a higher reoperation-free survival as compared to other localizations (log-rank P = 0.002). The localization of leaflet pathology but not the repair method was an independent predictor for reoperation-free survival (HR 1.455, 95% confidence interval 1.098–1.930; P = 0.009). CONCLUSIONS In minimally invasive mitral surgery for degenerative disease, chordal replacement yields higher rates of periprocedural success than leaflet resection. Posterior leaflet pathology is an independent predictor of reoperation-free survival.

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Ozen, Anil, Ertekin Utku Unal, Hamdi Mehmet Ozbek, Gorkem Yigit, and Hakki Zafer Iscan. "Optimizing P2 Neochordal Length and Stability in Mitral Valve Repair With Use of a Polypropylene Loop." Texas Heart Institute Journal 47, no. 3 (June 1, 2020): 207–9. http://dx.doi.org/10.14503/thij-18-6913.

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Determining the optimal length of artificial chordae tendineae and then effectively securing them is a major challenge in mitral valve repair. Our technique for measuring and stabilizing neochordae involves tying a polypropylene suture loop onto the annuloplasty ring. We used this method in 4 patients who had moderate-to-severe mitral regurgitation from degenerative posterior leaflet (P2) prolapse and flail chordae. Results of intraoperative saline tests and postoperative transesophageal echocardiography revealed only mild insufficiency. One month postoperatively, echocardiograms showed trivial regurgitation in all 4 patients. We think that this simple, precise method for adjusting and stabilizing artificial chordae will be advantageous in mitral valve repair.

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Kwan, Jun, Rashid M. Ahmad, Deborah A. Agler, Takahira Shiota, Delos M. Cosgrove, and James D. Thomas. "Three-dimensional geometric change of mitral annulus after mitral valve repair in mitral valve prolapse." Journal of the American College of Cardiology 39 (March 2002): 430. http://dx.doi.org/10.1016/s0735-1097(02)81929-5.

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Chan, Vincent, C. David Mazer, Faeez Mohamad Ali, Adrian Quan, Marc Ruel, Benoit E. de Varennes, Alexander J. Gregory, et al. "Randomized, Controlled Trial Comparing Mitral Valve Repair With Leaflet Resection Versus Leaflet Preservation on Functional Mitral Stenosis." Circulation 142, no. 14 (October 6, 2020): 1342–50. http://dx.doi.org/10.1161/circulationaha.120.046853.

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Background: Equipoise exists between the use of leaflet resection and preservation for surgical repair of mitral regurgitation caused by prolapse. We therefore performed a randomized, controlled trial comparing these 2 techniques, particularly in regard to functional mitral stenosis. Methods: One hundred four patients with degenerative mitral regurgitation surgically amenable to either leaflet resection or preservation were randomized at 7 specialized cardiac surgical centers. Exclusion criteria included anterior leaflet or commissural prolapse, as well as a mixed cause for mitral valve disease. Using previous data, we determined that a sample size of 88 subjects would provide 90% power to detect a 5–mm Hg difference in mean mitral valve gradient at peak exercise, assuming an SD of 6.7 mm with a 2-sided test with α=5% and 10% patient attrition. The primary end point was the mean mitral gradient at peak exercise 12 months after repair. Results: Patient age, proportion who were female, and Society of Thoracic Surgeons risk score were 63.9±10.4 years, 19%, and 1.4±2.8% for those who were assigned to leaflet resection (n=54), and 66.3±10.8 years, 16%, and 1.9±2.6% for those who underwent leaflet preservation (n=50). There were no perioperative deaths or conversions to replacement. At 12 months, moderate mitral regurgitation was observed in 3 subjects in the leaflet resection group and 2 in the leaflet preservation group. The mean transmitral gradient at 12 months during peak exercise was 9.1±5.2 mm Hg after leaflet resection and 8.3±3.3 mm Hg after leaflet preservation ( P =0.43). The participants had similar resting peak (8.3±4.4 mm Hg versus 8.4±2.6 mm Hg; P =0.96) and mean resting (3.2±1.9 mm Hg versus 3.1±1.1 mm Hg; P =0.67) mitral gradients after leaflet resection and leaflet preservation, respectively. The 6-minute walking distance was 451±147 m for those in the leaflet resection versus 481±95 m for the leaflet preservation group ( P =0.27). Conclusions: In this adequately powered randomized trial, repair of mitral prolapse with either leaflet resection or leaflet preservation was associated with similar transmitral gradients at peak exercise at 12 months postoperatively. These data do not support the hypothesis that a strategy of leaflet resection (versus preservation) is associated with a risk of functional mitral stenosis. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier NCT02552771.

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Penso, Marco, Mauro Pepi, Valentina Mantegazza, Claudia Cefalù, Manuela Muratori, Laura Fusini, Paola Gripari, Sarah Ghulam Ali, Enrico G. Caiani, and Gloria Tamborini. "Machine Learning Prediction Models for Mitral Valve Repairability and Mitral Regurgitation Recurrence in Patients Undergoing Surgical Mitral Valve Repair." Bioengineering 8, no. 9 (August 25, 2021): 117. http://dx.doi.org/10.3390/bioengineering8090117.

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Background: Mitral valve regurgitation (MR) is the most common valvular heart disease and current variables associated with MR recurrence are still controversial. We aim to develop a machine learning-based prognostic model to predict causes of mitral valve (MV) repair failure and MR recurrence. Methods: 1000 patients who underwent MV repair at our institution between 2008 and 2018 were enrolled. Patients were followed longitudinally for up to three years. Clinical and echocardiographic data were included in the analysis. Endpoints were MV repair surgical failure with consequent MV replacement or moderate/severe MR (>2+) recurrence at one-month and moderate/severe MR recurrence after three years. Results: 817 patients (DS1) had an echocardiographic examination at one-month while 295 (DS2) also had one at three years. Data were randomly divided into training (DS1: n = 654; DS2: n = 206) and validation (DS1: n = 164; DS2 n = 89) cohorts. For intra-operative or early MV repair failure assessment, the best area under the curve (AUC) was 0.75 and the complexity of mitral valve prolapse was the main predictor. In predicting moderate/severe recurrent MR at three years, the best AUC was 0.92 and residual MR at six months was the most important predictor. Conclusions: Machine learning algorithms may improve prognosis after MV repair procedure, thus improving indications for correct candidate selection for MV surgical repair.

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Cagli, Kerim, Gokhan Lafci, and Omer Cicek. "An Alternative “No Resection” Technique for Posterior Mitral Leaflet Prolapse Repair: Reverse T-Plasty." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 9, no. 4 (July 2014): 334–36. http://dx.doi.org/10.1097/imi.0000000000000076.

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Reverse T-plasty is an alternative “no resection” technique for posterior mitral leaflet prolapse repair that is inspired by butterfly resection. It combines mediolateral and anteroposterior plane foldings of the posterior leaflet without any resection and shortens cardiopulmonary bypass and cross-clamping time.

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Koo, Hyun Jung, Dong Hyun Yang, Sang Young Oh, Joon-Won Kang, Dae-Hee Kim, Jae-Kwan Song, Jae Won Lee, Cheol Hyun Chung, and Tae-Hwan Lim. "Demonstration of Mitral Valve Prolapse with CT for Planning of Mitral Valve Repair." RadioGraphics 34, no. 6 (October 2014): 1537–52. http://dx.doi.org/10.1148/rg.346130146.

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Zhan-Moodie, Samantha, Kirthana Sreerangathama Suresh, Alison Stauffer, and Muralidhar Padala. "Mitral Valve Chordal Force Redistribution Before and After Repair of Mitral Valve Prolapse with Edge-Edge Repair." Structural Heart 4, sup1 (February 13, 2020): 167–68. http://dx.doi.org/10.1080/24748706.2020.1716606.

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Pfannmueller, Bettina, Martin Misfeld, Alexander Verevkin, Jens Garbade, David M. Holzhey, Piroze Davierwala, Joerg Seeburger, Thilo Noack, and Michael A. Borger. "Loop neochord versus leaflet resection techniques for minimally invasive mitral valve repair: long-term results." European Journal of Cardio-Thoracic Surgery 59, no. 1 (August 10, 2020): 180–86. http://dx.doi.org/10.1093/ejcts/ezaa255.

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Abstract OBJECTIVES Non-leaflet resection techniques including loop chordal replacement are being used with increasing frequency, but the long-term results of these techniques are still unknown. The aim of this study was to compare the long-term results of loop neochord replacement with leaflet resection techniques in patients undergoing minimally invasive mitral valve (MV) repair for MV prolapse. METHODS Between 1999 and 2014, 2134 consecutive MV prolapse patients underwent minimally invasive MV repair with isolated loop (n = 1751; 82.1%) or resection techniques (n = 383, 17.9%) at our institution. Follow-up data were available for 86% of patients with a mean follow-up time of 6.1 ± 4.3 years. RESULTS The 30-day mortality was 0.8% for all patients (loop: 0.7%, resection: 1.6%; P = 0.09). Leaflet resection was associated with more moderate or more mitral regurgitation on predischarge echocardiography (P = 0.003). The 1-, 5- and 10-year survival rates were 98 ± 1%, 95 ± 1% and 86 ± 2% for the loop technique versus 97 ± 1%, 92 ± 1% and 81 ± 2% for resection patients, respectively (P = 0.003). Significant predictors for late mortality were MV repair technique (P = 0.004), left ventricular ejection fraction (P < 0.001), age (P < 0.001) and myocardial infarction (P < 0.001). Freedom from MV reoperation at 1, 5 and 10 years was 98 ± 1%, 97 ± 1%, 97 ± 1% and 97 ± 1%, 97 ± 1%, 96 ± 1% for patients operated on with the loop technique and leaflet resection (P = 0.4). CONCLUSIONS In our patient cohort, MV repair with loop chordal replacement is associated with less early recurrent mitral regurgitation and very good long-term results when compared to classical leaflet resection techniques for MV prolapse and is therefore an excellent option for such patients.

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Raanani, Ehud, Ehud Schwammenthal, Yaron Moshkovitz, Hillit Cohen, Alexander Kogan, Yael Peled, Leonid Sternik, and Eilon Ram. "Repair with annuloplasty only of balanced bileaflet mitral valve prolapse with severe regurgitation." European Journal of Cardio-Thoracic Surgery 61, no. 4 (December 23, 2021): 908–16. http://dx.doi.org/10.1093/ejcts/ezab548.

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Abstract OBJECTIVES Repair of severe mitral valve and mitral regurgitation (MR) in patients with degenerative bileaflet pathology can be challenging. Initial results with a ring-only repair (ROR) approach have shown promising results, but long-term outcomes in larger series are lacking. We report on outcomes of ROR in severe MR secondary to bileaflet prolapse, including Barlow’s disease. METHODS Eighty patients with degenerative multi-segment bileaflet disease underwent ROR for severe MR with a predominantly central regurgitant jet indicating balanced bileaflet prolapse. The main outcome measure of this study was long-term recurrent MR probability. Secondary outcomes were late mortality, reoperation and in-hospital complications. RESULTS The mean age was 53 ± 15 years and 54% were males. The mean ejection fraction was 59.2 ± 6.6, 24% and 40% had atrial fibrillation. Barlow’s disease was found in 77% of the patients. Minimally invasive surgery was performed in 15 patients (19%). There were no perioperative mortalities or cerebrovascular events in the entire cohort. Post-repair mild outflow tract obstruction (systolic anterior motion) was observed in 4 patients (5%) after ROR. In a mean follow-up of 60 ± 48 months, there was 1 case of death. At follow-up, there was 1 (1%) reoperation due to recurrent MR, and 4 patients who had recurrent moderate or more MR. The 10-year freedom from recurrent MR was 97%. None had severe MR at the latest follow-up. CONCLUSIONS In patients with severe MR and a central regurgitant jet secondary to balanced multi-segment bileaflet mitral valve prolapse, ROR is a simple and efficient approach providing excellent long-term results without a substantial risk of systolic anterior motion.

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