Triangular resection and folding of posterior leaflet for mitral valve repair.

The conventional treatment of mitral insufficiency, due to posterior leaflet prolapse, is quadrangular resection. This technique sacrifices a great amount of valve tissue resulting in leaflet stiffness and altered annular geometry. To avoid such problems we performed a small triangular leaflet resection sparing the second-order chordae, a folding plasty, implantation of artificial chordae, and annuloplasty. Fourteen patients underwent this procedure. No hospital death and no repair failure were observed. Echocardiography at 12 months on 12 patients showed trivial incompetence in three and mild in one and an overall improvement of end-diastolic and end-systolic diameters. Our technique has the main objectives of sparing second-order chordae and subvalvular apparatus in order to preserve mobility of the posterior mitral leaflet, left ventricular geometry, and function. Preliminary results are encouraging.