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Ann Thorac Surg 1999;68:1690-1691
© 1999 The Society of Thoracic Surgeons

Invited Commentaries

Tirone E. David, MDa

a The Toronto Hospital, Eaton Bldg, NW, 13th Floor, Room 222, 200 Elizabeth, Toronto, ON M5G 2C4 Canada

Invited commentary

Gregori and associates described their experience with correction of prolapse of the anterior leaflet of the mitral valve by transferring the posterior leaflet of the tricuspid valve with its chordae tendineae and papillary muscle to the mitral valve. They performed this operation on 20 patients, with only 2 failures during a mean follow-up of a few years. Other surgeons have also performed this operation, and have even used the posterior leaflet of the tricuspid valve to replace segments of the anterior leaflet of the mitral valve in cases of infective endocarditis or calcification.

Although I agree that there may be an occasional patient who would benefit from this technique, it is by no means superior to more standard and simpler ones, to correct prolapse of the anterior leaflet of the mitral valve. Chordal transfer from the posterior to the anterior leaflet of the mitral valve, or transfer of a chorda from the body to the free margin of the anterior leaflet and chordal replacement with expanded polytetrafluoroethylene sutures, are the standard methods. They do not amputate part of the tricuspid valve to repair the incompetent mitral valve, and have provided excellent long-term results. In our hands, the freedom from recurrent mitral regurgitation in several hundred patients has been 95% at 10 years. These are the standards that Gregori’s method would have to be measured against.


Related Article

Partial tricuspid valve transfer for repair of mitral insufficiency due to ruptured chordae tendineae
Francisco Gregori, Jr, Celso O. Cordeiro, Ulisses A. Croti, Sergio S. Hayashi, Samuel S. da Silva, and Thelma E.F. Gregori
Ann. Thorac. Surg. 1999 68: 1686-1690. [Abstract] [Full Text] [PDF]




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