2 | CASE SERIES
| Approach to Artificial Chordae Implantation
An ePTFE suture (CV-4) is passed through the fibrous region of a
papillary muscle on the same side of the valve (ie, medial or lateral)
as the region of prolapse. Each end of the suture is brought up to the
leaflet edge and passed twice through the leaflet tissue in the region
of prolapse; the needles pass from the ventricular to the atrial aspect
and finish adjacent to each other on the atrial aspect. The chordal
length is adjusted to a level to prevent prolapse, using the region of
A1‐P1 as a reference point and ensuring a generous zone of coaptation
(Figure 1). The suture is tied on the atrial side of the MV leaflet. All
repairs include a posterior annuloplasty band.
| Case 1
A 42 year old male presented with 4+ MR, annular dilatation, mild left
ventricular dilatation and mild left ventricular dysfunction. At index
operation he had extensive posterior leaflet prolapse with ruptured
chordae to P2/P3. Two sets of artificial chords were fixed to the
posterior leaflet and a 35-mm annuloplasty band placed. No SAM or MR was
noted after the case, and leaflet coaptation was excellent. Three months
postoperative, he presented with 3-4+ MR and mild symptoms. At
reoperation, previously placed chords remained intact but he had P2
prolapse with a noticeably remodeled ventricle that was now normal in
size. His valve was repaired with sliding valvuloplasty.
| Case 2
A 51 year old male presented with 4+ MR, LV dilatation and mild
biventricular dysfunction. At index operation he had multiple ruptured
chords to his posterior leaflet. Artificial chords were fixed to the
posterior leaflet and a 35-mm annuloplasty band was placed. He presented
6 months later with 4+ MR and NYHA Class II symptoms; his ventricular
function had improved and ventricular size was now normal. At
reoperation, artificial chords remained intact but were now too long,
causing posterior leaflet prolapse. His valve was repaired with sliding
valvuloplasty.