COMMISSUROPLASTY WITH PERICARDIUM
Lai and Chard describe a commissuroplasty for a defect caused by extensive debridement of the leaflet and annulus (Fig. 10.1) (1).
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Figure 10.1 Commissuroplasty. A: Vegetation and abscess located in the posteromedial commissure of the mitral valve. B: Radical debridement of the infected annulus and adjacent leaflets resulted in a large defect in the mitral valve orifice. The annular defect was patched with pericardium. C: The leaflet remnants were approximated at the leading edge with a horizontal mattress suture to form a zone of apposition (inset). The residual D-shaped defect between the mitral annular patch and apposed leaflets was closed with a pericardial patch, thus restoring valve competence. (From Lai DT, Chard RB. Commissuroplasty: a method of valve repair for mitral and tricuspid endocarditis. Ann Thorac Surg. 1999;68:1727-1730.) |
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SLIDING LEAFLET PLASTY OR PARACOMMISURAL SLIDING PLASTY
Figures 10.2 and 10.3 show the application of the sliding plasty technique for commissural prolapse used by van Herwerden et al. (2).
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Figure 10.2 A: Incisions; dark area is resected. B: Completed repair. (From van Herwerden LA, Taams MA, Bos E. Repair of commissural prolapse by extended leaflet sliding.Ann Thorac Surg. 1994;57:387-390.) |
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Figure 10.3 Rotation paracommissural sliding plasty. (From Ng CK, Punzengruber C, Pachinger O, et al. Valve repair in mitral regurgitation complicated by severe annulus calcification. Ann Thorac Surg. 2000;70:53-58.) |
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Figure 10.4 Paracommissural edge-to-edge repair. (From Maisano F, Torracca L, Oppizzi M, et al. The edge-to-edge technique: a simplified method to correct mitral insufficiency. Eur J Cardiothorac Surg. 1998;13:240-245.) |
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Figure 10.5 Medial commissuroplasty. (Clip 6, Case 4) |
PARACOMMISSURAL EDGE-TO-EDGE REPAIR (COMMISSUROPLASTY)
A paracommissural edge-to-edge repair is a simpler procedure than sliding commissuroplasty for treating prolapse at one commissure. This can be performed with a figure-of-eight suture or a pledgeted or plain mattress suture (Fig. 10.4). This approach is quick and reliable and does not create stenosis (Fig. 10.5).
REFERENCES