Cutting the second order chords during mitral valve repair.

Autor: Calafiore AM; Department of Cardiovascular Diseases, Gemelli Molise, Campobasso, Italy., Prapas S; Division of Cardiac Surgery A, Henry Dunant Hospital, Athens, Greece., Totaro A; Department of Cardiovascular Diseases, Gemelli Molise, Campobasso, Italy., Guarracini S; Department of Cardiology, 'Pierangeli' Hospital, Pescara, Italy., Cargoni M; Department of Surgical, Oncologic and Stomatological Disciplines, GVM Care & Research, Maria Eleonora Hospital, University of Palermo, Palermo, Italy., Katsavrias K; Division of Cardiac Surgery A, Henry Dunant Hospital, Athens, Greece., Fattouch K; Department of Cardiac Anesthesia, Mazzini Hospital, Teramo, Italy., Di Mauro M; Departmente of Cardio-Thoracic and Vascular Surgery, Heart and Vascular Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands.
Jazyk: angličtina
Zdroj: Journal of cardiac surgery [J Card Surg] 2022 Dec; Vol. 37 (12), pp. 4072-4078. Date of Electronic Publication: 2022 Nov 15.
DOI: 10.1111/jocs.17194
Abstrakt: The chordae tendinae connect the papillary muscles (PMs) to the mitral valve. While the first-order chordae serve to secure the leaflets to maintain valve closure and prevent mitral valve prolapse, the second-order chordae are believed to play a role in maintaining normal left ventricle size and geometry. The PMs, from where the chordae tendinae originate, function as shock absorbers that compensate for the geometric changes of the left ventricular wall. The second-order chordae connect the PMs to both trigons under tension. The tension distributed towards the second-order chordae has been demonstrate to be more than threefold that in their first-order counterpart. Cutting the second-order chordae puts all the tension on the first-order chordae, which are then closer to their rupture point. However, it has been experimentally demonstrated that the tension at which the first-order chordae break is 6.8 newtons (N), by far higher than the maximal tension reached, that is 0.4 N. Even if the clinical reports have been favorable, the importance of cutting the second-order chordae to recover curvature of the anterior leaflet and increase the coaptation length between the mitral valve leaflets has been slowly absorbed by the surgical world. Nevertheless, there are progressive demonstrations that chordal tethering affects the anterior leaflet not only in secondary, but also in primary mitral regurgitation, having a not negligible role in the long-term outcome of mitral repair.
(© 2022 Wiley Periodicals LLC.)
Databáze: MEDLINE
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