"Collar-like" neocommissure in mitral valve repair for extensive commissural prolapse

Hoshun Chong; Jie Li; Yunxing Xue; Xiyu Zhu; He Zhang; Junxia Wang; Hailong Cao

doi:10.1016/j.xjtc.2022.07.025

"Collar-like" neocommissure in mitral valve repair for extensive commissural prolapse

JTCVS Tech. 2022 Aug 13:15:73-77. doi: 10.1016/j.xjtc.2022.07.025. eCollection 2022 Oct.

Authors

Hoshun Chong¹, Jie Li², Yunxing Xue¹, Xiyu Zhu¹, He Zhang¹, Junxia Wang¹, Hailong Cao¹

Affiliations

¹ Department of Cardiothoracic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
² Department of Ultrasound, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.

Abstract

Objectives: Mitral valve repair for extensive commissural prolapse is complex; several methods have been reported with variable results. To restore the leaflet area, we introduced an innovative and effective method rather than a simple folding technique through reconstructing a neocommissure with a "collar-like" plasty technique.

Methods: From 2016 to 2021, 62 patients with mitral valve extensive commissural prolapse that received the "collar-like" plasty technique were included.

Results: The mean age was 51.7 ± 13.8 years, and 38 (61%) were female. Postplasty transesophageal echocardiography showed the mean transvalvular pressure gradients were 3.8 ± 1.2 mm Hg, end diastolic peak flow velocity was 1.1 ± 0.3 m/s, and coaptation height was 7.9 ± 1.1 mm. During the follow-up period of 3 to 6 months, no deaths or cardiovascular-/valvular plasty-related adverse events occurred. All patients regained their heart function and returned to normal physical activities.

Conclusions: The "collar-like" plasty technique can be safely performed for patients with extensive commissural prolapse. Echocardiography revealed that the technique can restore the leaflet area of low transvalvular pressure and flow velocity.

Keywords: AC, anterior commissure; MVP, mitral valve prolapse; NYHA, New York Heart Association; TEE, transesophageal echocardiography; TTE, transthoracic echocardiography; commissure prolapse; mitral valve repair.