PMC10225496_01
Intraoperative transesophageal echocardiography. (A,B): before retensioning procedure 2D + color Doppler and 3D; eccentric regurgitation jet directed to AML and reprolapsing PML (arrow). (C,D): after retensioning procedure 2D + color Doppler and 3D: (C) central postprocedural mild MR (arrow) is showed. (D) Mild residual PML prolapse is highlighted (arrow) and a good coaptation between AML and PML is reached. AML, anterior mitral leaflet; MR, mitral regurgitation; PML, posterior mitral leaflet.
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F1
TEE confirmed these findings, in the absence of native/artificial chordal rupture and in the presence of significant LVRR, causing NCRE and reprolapse of the treated leaflet (Figures 1A,B). The final result was residual mild central MR (Figures 1C,D).
(A) Apex re-exposure through previous left mini-thoracotomy reopening: Identification of the chordal loops sprouting from the Teflon pledget (arrow) corresponding to the ventricular access site. (B) Samples sizing: temporary samples made of tourniquet tubing pieces (arrow) are positioned inside the loops, between the knots and the Teflon pledget. (C) Defining final samples: once the desired shape is set, the tourniquet pieces are fixed together with a 4-0 prolene suture and then covered with a Gore-Tex vascular prosthesis (arrow). (D) Samples fixation: definitely samples (arrows) are inserted inside the chordal loop and then fixed by suturing the vascular prosthesis to the corresponding loop with a 4-0 prolene suture.
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F2
These samples were built by a variable number of tourniquet tubing pieces fixed together (Figure 2B); the correct size was defined by increasing/decreasing the thickness of each sample by adding/removing tourniquet tubing pieces. The final length of the neochords was established once adequate coaptation was restored and optimal correction of MR was obtained. Each final sample (Figure 2C) was then inserted inside a Gore-Tex 8 mm caliber vascular prosthesis. We built three samples (one for each chordal loop) and fixed them to the neochordal loops with sutures (Figure 2D).