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Ann Thorac Surg 1999;67:294
© 1999 The Society of Thoracic Surgeons

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Correspondence

Reply

^a ELGIN Cardiac Surgery, SC, 901 Center St, Suite 307, Elgin, IL 60120, USA

To the Editor

I thank Drs Aris and Gil-Jaurena for their comment on my article [1] about preservation of anterior and posterior leaflet in a tilting-disc mitral valve.

I do share their concerns about the possibility of valve thrombosis and left ventricular outflow obstructions when both anterior and posterior leaflets are preserved [2, 3] and understand why most surgeons completely excise the anterior leaflet. However, in the technique described in my article, I do remove the unsupported portion of the anterior leaflet by trimming the anterior leaflet into three to four islands of tissue with the attached underlying chordae tendinae. This maneuver will minimize the amount of retained valve tissue to decrease the possibility of inflow ventricular obstruction caused by the prosthetic valve and subvalvular apparatus. In addition, all the remaining islands of the anterior leaflet tissues are completely transposed under the posterior leaflet, and thus this approach completely eliminates the possibility of left ventricular outflow tract obstruction.

I believe the technique described in my article [1] provides definite advantages in allowing the safe implantation of a tilting-disc valve in the mitral position with preservation of both anterior and posterior leaflets by eliminating serious potential complications such as impingement of disc movement or left ventricular outflow obstruction.

References

1. Choh J.H. Preservation of anterior and posterior leaflet in mitral valve replacement with a tilting disc valve. Ann Thorac Surg 1997;64:271-273.[Abstract/Free Full Text]
2. Demirtas M.M. Prosthetic mitral valve thrombosis after replacement with preservation of all chordae. Ann Thorac Surg 1997;63:600-601.[Free Full Text]
3. Esper E., Ferdinand F.D., Aronson S., Karp R.B. Prosthetic mitral valve replacement: late complication after native valve preservation. Ann Thorac Surg 1997;63:541-543.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Joong H. Choh Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Choh, J. H. Search for Related Content PubMed Articles by Choh, J. H. Related Collections Related Article