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ISSN (On-line): 1678-9741 Impact Factor: 0.809
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Volume 3 Number 2, May - August, 1988

ORIGINAL ARTICLE

DOI: http://dx.doi.org/10.1590/S0102-76381988000200005

New technique for transference of chordae tendinae following mitral commissurotomy

Nova técnica de transferência de cordas para sustentação das cúspides da valva mitral, após abertura completa de suas comissuras

José Alberto Caliani; Ulric Hvass; Yves Pansard; Jean Langlois

Correspondence To:
46, Rue Henri Huchard
Paris 75018, France

ABSTRACT
Since 1983, 40 consecutive patients with mitral stenosis and significant disease of the subvalvular apparatus underwent open heart mitral commissurotomy. The aim of the study was to evaluate the effects of an unrestricted dilatation of the two commissures followed by repair of the subsequent mitral regurgitation. The mitral regurgitation created by this procedure in 24 cases was corrected by transferring 2 to 6 chordae tendinae to the free border of the anterior and/or posterior leaflet in the commissural region. A central regurgitant lesion due to lack of coaptation of the valvular surfaces was treated by annuloplasty with a Carpentier prosthesis in 12 cases. The subvalvular abnormalities were treated by the conventional techniques of fenestration, resection and division of the papillary muscles. Thirty two of the 38 survivors had no residual murmur, and 6 had a short low intensity systolic murmur. The 2D echocardiographic study showed no residual stenosis. The residual systolic murmurs were evaluated by pulsed Doppler and corresponded to well localized regurgitation. This extensive operative technique gives very good immediate valvular results, which, associated with an adequate subvalvular procedure, are considered to be an important prognostic factor.

Keywords heart valves, surgery.


RESUMO
Desde 1983, 40 pacientes consecutivos, portadores de estenose mitral com alterações subvalvares, tais como: fusão e encurtamento das cordas, associadas a sinéquia dos músculos papilares, foram submetidos a comissurotomia mitral a "céu aberto". Com o intuito de ganhar área efetiva maior de abertura da valva mitral (sem restrições), as comissuras foram abertas, amplamente, às vezes não respeitando as cordas que sustentam as cúspides. A insuficiência mitral provocada, em 4 casos, como conseqüência, foi corrigida mediante a transferência de 2 a 6 cordas, ao nível da borda livre da cúspide anterior, ou posterior, da valva, na região das comissuras. A presença de uma regurgitação central por falha na coaptação das cúspides valvares, foi tratada, em 12 casos, com o implante de anel profético de Carpentier. As anomalias do aparelho subvalvar foram abordadas pelas técnicas convencionais: desbridamento, ressecção e abertura dos músculos papilares. Dos 38 sobreviventes, 32 não apresentam sopro de regurgitação mitral e os 6 restantes, apenas sopro sistólico de +/+ +. A avaliação pós-operatória, mediante ecocardiografia bidemensional, demonstrou abertura valvar satisfatória e ausência de estenose residual. Os pacientes que apresentam sopro sistólico mitral residual foram estudados com Doppler, concluindo que se trata de regurgitação bem localizada e sem repercussão hemodinâmica. Esta nova técnica operatória pode ser "extensível" ao tratamento do prolapso da valva mitral.

Palavras-Chave valvas cardíacas, cirurgia.

Full text available only in portuguese PDF format.

REFERENCES

1. CARPENTIER, A. - Cardiac valve surgery: the french correction. J. Thorac. Cardiovasc. Surg., 86(3): 323-337, 1983. [MedLine]

2. ENRIQUEZ-SARANO, M.; LUOVARD, Y.; DARMON, D.; TANCHA, W.; ACAR, J. - Faut-il encore faire des commissurotomies mitrales a coeur fermé?: a propos de 168 interventions dont 108 à coeur ouvert et 60 à coeur fermé. Arch. Mal. Coeur, 77(7): 782-790, 1984.

3. GROSS, R. I.; CUNNINGHAM, J. N.; SMIVELY, S. L.; CATINELLA, F. P.; NATHAN, I. M.; ADAMS, P. X.; SPENCER, F. C. - Long-term results of open radical, mitral commissurotomy: ten years follow-up study of 202 patients. Am. J. Cardiol., 47(4): 821-825, 1981. [MedLine]

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