43.3-year durability of a Smeloff-Cutter ball-caged mitral valve

Extended durability of mechanical heart valves has been documented for many years. We describe a case of a ball-caged mechanical valve implanted 43.3 years previous to developing valve dysfunction. The patient presented with both prosthetic valve stenosis and insufficiency. This Smeloff-Cutter valve (Cutter Laboratories, Berkeley, CA) in the mitral position was dysfunctional due to lipid absorption, which resulted in ball variance and concomitant pannus growth prevented optimal seating of the ball in its cage. This is the longest length of time in which a Smeloff-Cutter mechanical valve has been originally implanted.     

A device for ensuring the neochordae replacement in mitral valve repair

We have developed a new device for maintaining artificial chordae at the appropriate length during the tying of Gore-Tex sutures (W. L. Gore and Assoc, Flagstaff, AZ). This double-armed, double-hooked device is inserted through the loop formed by the neochordae, which is anchored in the papillary muscle and passed through the prolapsing segment. The device pulls up both leaflets and maintains the neochordae at the same length as that of the opposing normal chordae. The prolapsed leaflet is suspended at the same height as the facing leaflet, enabling the accurate and reproducible placement of neochordae.     

Transventricular mitral valve operations

We report transventricular mitral valve operations in 2 patients with severe mitral regurgitation and postinfarction left ventricular rupture and pseudoaneurysm. The first patient had direct papillary muscle involvement necessitating replacement of the mitral valve. The second patient had indirect mitral involvement allowing for placement of an atrial mitral annuloplasty ring via the left ventricle. Both patients showed no mitral valve regurgitation after replacement or repair and had uneventful postoperative recoveries. These cases demonstrate a feasible, alternative, transventricular approach to mitral valve replacement and repair.     

Measured tube technique for ensuring the correct length of slippery artificial chordae in mitral valvuloplasty

Mitral valvuloplasty using Gore-Tex (W.L. Gore & Associates, Inc, Flagstaff, AZ) as artificial chordae is often associated with difficulties in determining the length of the artificial chordae, as well as preventing knot slippage, especially for patients with broad anterior leaflet prolapse. We describe a simple technique that enables surgeons to easily determine the correct length of the artificial chordae and tie slippery knots without using a specific device.     

Patch repair of a giant left ventricular pseudoaneurysm after mitral valve replacement

Left ventricular pseudoaneurysm (LVP) is a rare cardiac disorder. We describe the repair of a large LVP that was identified in a 73-year-old woman 10 months after she underwent mitral valve replacement for infective endocarditis at another hospital 10 months previously. Follow-up echocardiography showed an enlarged large mass beside the left ventricle, and computed tomography revealed a LVP and an orifice just beside the mitral annulus. We removed the implanted valve and closed the large orifice (35×4 mm) using a Xenomedica (Baxter Healthcare Corp, Horw, Switzerland) patch. Computed tomography 3 months later revealed a thrombosed LVP.     

Modified edge-to-edge technique for correction of congenital mitral regurgitation in infants and children

Since 2008, 28 patients with congenital mitral regurgitation have undergone mitral valve repair with a modified edge-to-edge technique at our institution. The regurgitant mitral leaflet was sutured with a pledget-reinforced, horizontal mattress suture with No. 4-0 polypropylene on the ventricle side and a pledget-reinforced mattress suture with Gore-Tex sutures (W.L. Gore & Associates, Flagstaff, AZ) and Dacron pledgets (Chest, Shanghai) placed on the anterior and posterior annulus corresponding to the edge-to-edge suturing site. Early results are encouraging, but a longer follow-up is needed.     

Posterior chordal cutting in rheumatic mitral regurgitation due to hypomobility of the posterior leaflet

A technique is described for correction of mitral regurgitation when the posterior leaflet has a reasonable length (approximately 10 mm), but its movements are limited by thickened and short chords. To avoid further retraction when a band or a ring is positioned to force leaflets coaptation, native chords are replaced by artificial chords (leaving 10 mm of extra length), which are then cut. In 6 patients, after 6 months of follow-up, the results are good.