Mitral insufficiency due to an isolated anterior-leaflet cleft: correction with an autologous pericardial patch supported by artificial chordae

Abstract

Congenital clefts of the mitral valve without an associated atrioventricular canal defect are rare, and they may cause mitral insufficiency that requires surgical correction. Repair is typically by direct suture; however, if the cleft is especially wide, the use of this technique may distort the valve leaflet and cause poor coaptation with valvular insufficiency.Herein, we present the case of a 39-year-old woman who had severe mitral valve insufficiency secondary to a wide isolated cleft of the anterior mitral leaflet. The valve was reconstructed with an autologous pericardial patch supported by polytetrafluoroethylene neochordae and an implanted annuloplasty ring. Echocardiographic examination 1 year postoperatively showed excellent competence of the mitral valve and good coaptation of the leaflets. To our knowledge, this is the 1st report that describes the use of artificial neochordae to support an autologous pericardial patch in the repair of a cleft in the anterior mitral valve leaflet.

Keywords: Adult; cardiac surgical procedures; echocardiography; heart defects, congenital/complications/surgery; mitral valve insufficiency/etiology/surgery; mitral valve/abnormalities/pathology/surgery; surgical techniques; treatment outcome.

Fig. 1 Simultaneous A) 2-dimensional and B) color-flow Doppler transthoracic echocardiograms (parasternal short-axis view, in diastole) show a cleft in the anterior mitral leaflet that appears to point toward the left ventricular outflow tract (A, arrows), and diastolic blood inflow through the cleft (B, arrows).

Fig. 2 Transthoracic echocardiogram (3-dimensional reconstruction) shows the width of the cleft (arrows).

Fig. 3 Intraoperatively before surgical correction, simultaneous A) 2-dimensional and B) color-flow Doppler transesophageal echocardiograms (midesophageal view) show a lack of coaptation of the mitral valve leaflets corresponding to the cleft (A) and severe mitral regurgitation due to the cleft (B, arrows).

Fig. 4 Intraoperative photograph of the mitral valve shows a cleft in the central portion of the anterior mitral leaflet.

Fig. 5 Drawing depicts the anterior mitral leaflet after repair with glutaraldehyde-treated autologous pericardium and 2 pairs of polytetrafluoroethylene neochordae.

Fig. 6 Intraoperatively after surgical correction, simultaneous A) 2-dimensional and B) color-flow Doppler transesophageal echocardiograms (midesophageal view) show restored coaptation of the mitral leaflets and no residual mitral regurgitation.