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Ann Thorac Surg 2001;72:535-540
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

Influence of anterior mitral leaflet second-order chordae on leaflet dynamics and valve competence

Tomasz A. Timek, MDa, Sten Lyager Nielsen, MDc, G. Randall Green, MDa, Paul Dagum, MD, PhDa, Ann F. Bolger, MDb, George T. Daughters, MSa,d, J. Michael Hasenkam, MDc, Neil B. Ingels, Jr, PhDa,d, D. Craig Miller, MDa

a Department of Cardiovascular and Thoracic Surgery, Stanford University School of Medicine, Stanford, California, USA
b Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
c Department of Cardiothoracic and Vascular Surgery, Aarhus University, Aarhus, Denmark
d Department of Cardiovascular Physiology and Biophysics, Research Institute of the Palo Alto Medical Foundation, Palo Alto, California, USA

Accepted for publication April 5, 2001.

Address reprint requests to Dr Miller, Department of Cardiovascular and Thoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, California 94305-5247
e-mail: dcm{at}stanford.edu

Background. Chordal transposition is used in mitral valve repair, yet the effects of second-order chord transection on valve function have not been extensively studied. We evaluated leaflet coaptation, three-dimensional anterior mitral valve leaflet shape, and valve competence after cutting anterior second-order chordae.

Methods. In 8 sheep radiopaque markers were affixed to the left ventricle, mitral annulus, and leaflets. Animals were studied immediately with biplane videofluoroscopy and echocardiography before (Control) and after (Cut2) severing two anterior second-order "strut" chordae. Leaflet coaptation was assessed as separation between leaflet edge markers in the midleaflet and near each commissure (anterior commissure, posterior commissure). Anterior leaflet geometry was determined 100 milliseconds after end-diastole from three-dimensional coordinates of 13 markers.

Results. Anterior leaflet geometry changed only slightly after chordal transection without inducing mitral regurgitation. Leaflet coaptation times were 79 ± 17 and 87 ± 22 milliseconds at the anterior commissure; 72 ± 21, 72 ± 19 milliseconds at midleaflet, and 71 ± 12 and 75 ± 8 milliseconds at the posterior commissure (p = NS) for Control and Cut2, respectively.

Conclusions. Cutting anterior second-order chordae did not cause delayed leaflet coaptation, alter leaflet shape, or create mitral regurgitation. These data indicate that transposition of second-order anterior chordae ("strut" chordae) is not deleterious to anterior leaflet motion per se.


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