The Annals of Thoracic Surgery, Vol 58, 452-457, Copyright © 1994 by The Society of Thoracic Surgeons
Mitral valve remodeling using autologous pericardium: an experimental study
A Borowski, M Sudkamp, E Rainer de Vivie and H Korb
Department of Cardiovascular Surgery, University of Cologne, Germany.
The aim of this study was to assess in vivo the efficacy of a new technique
for remodeling the mitral valve. In 6 dogs during cardiopulmonary bypass
and cardioplegic cardiac arrest, both mitral valve leaflets were totally
separated from the mitral ring and resected subtotally, leaving intact
their narrow margins with insertion sites of the chordae tendineae of the
first and second order. To mimic pathologic conditions, the chordae
tendineae were then altered by placing two shortening sutures for every
chordal stem. Based on standardized geometric calculations and using
autologous pericardium treated with 0.62% glutaraldehyde solution, the new
leaflets were then remodeled intraoperatively and sutured in place, merging
them with the subvalvular apparatus and the native mitral ring. After
restoration of stable circulatory conditions, valve function was evaluated
under rest and defined loading conditions using a 5.0-MHz ultrasound
transducer, applied epicardially. We found that intraoperative remodeling
of the mitral valve leaflets using autologous pericardium with preservation
of the subvalvular apparatus is possible and reproducible, and can be
performed even when the subvalvular apparatus is altered morphologically.
Functionally, the remodeled valve proved to be satisfactory under
conditions of rest and stress. The benefits conferred by autologous tissue,
the reproducibility of the surgical technique, the good functionality of
the remodeled valve, and the preservation of the subvalvular apparatus
could make this technique a useful surgical alternative for extensive
mitral valve reconstruction procedures in pediatric and adult patients.
