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eComment: Should triangular resection be an adequate approach for prolapsing posterior leaflet in all types of degenerative mitral valve disease?

Bakoulev Center for Cardiovascular Surgery, 121553 Moscow, Russia

Echocardiographic assessment of mitral valve morphology and performance after triangular resection of the prolapsing posterior leaflet for degenerative myxomatous disease

We read with great interest the article by Chiappini et al. [1]. We have a large experience in surgical treatment of degenerative mitral valve disease. Quadrangular resection and sliding-plasty for posterior mitral leaflet repair are usually performed. Rarely, we performed limited triangular resection of the prolapsing posterior mitral leaflet segment due to chordal rupture or elongation.

Etiologic distinction in the area of degenerative mitral valve repair is very important, because the etiology of degenerative mitral valve disease has an impact on the complexity and number of repair techniques required to achieve a successful valve repair [2].

The authors do not clarify the etiologic type of degenerative disease. The patients in the study received a ring size of 32 mm or less. It is likely that there were several patients with fibroelastic deficiency. We support the decision of authors to complete the valve repair by implanting the band in order to provide lifelong cure and for the rest of the life of the patient [3].

Whilst congratulating Chiappini et al. for their successful experience, we have some questions to the authors: did they perform triangular resection of prolapsing posterior mitral leaflet in all types of degenerative valve lesion? What will be their strategy for Barlow's disease bearing in mind that in this disease there are not only chordal elongation or rupture; Barlow's disease often presents several lesions coexisting in multiple segments of the same valve, which include also excess leaflet tissue.

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1. Chiappini B, Gregorini R, De Remigis F, Petrella L, Villani C, Di Pietrantonio F, Pavicevic S, Mazzola A. Echocardiographic assessment of mitral valve morphology and performance after triangular resection of the prolapsing posterior leaflet for degenerative myxomatous disease. Interac CardioVasc Thorac Surg 2009;9:287–290.[Abstract/Free Full Text]
2. Adams DH, Anyanwu AC. Seeking a higher standard for degenerative mitral valve repair: begin with etiology. J Thorac Cardiovasc Surg 2008;136:551–556.[Free Full Text]
3. David TE, Ivanov J, Armstrong S, Rakowski H. Late outcomes of mitral valve repair for floppy valves: implications for asymptomatic patients. J Thorac Cardiovasc Surg 2003;125:1143–1152.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Leo A. Bockeria Permission Requests Google Scholar Articles by Bockeria, L. A. Articles by Tsiskaridze, I. M. PubMed PubMed Citation Articles by Bockeria, L. A. Articles by Tsiskaridze, I. M. Related Collections Related Article