Echocardiographic evaluation of mitral tethering for 'chordal cutting' procedure.

'Chordal cutting' is a recently proposed surgical option for the treatment of functional mitral regurgitation due to leaflet tethering. With this technique the surgeon sections second order chordae, restores leaflet's convexity towards the left atrium and eliminates mitral incompetence. Preoperative assessment of tethering mechanism, degree of leaflet distortion, surface of coaptation, annular dilation, origin and quantification of valve incompetence by echocardiographic means is essential in indicating this surgical option. Intraoperative transesophageal evaluation is crucial to assess the morphology and the absence or degree of residual incompetence after procedure.