Kazan medical journalKazan medical journal0368-48142587-9359Eco-Vector169310.17816/KMJ1693Research ArticleThe use of a functional technique for neo-chords’ length determination during reconstructive operations for degenerative mitral regurgitationMukharyamovM Nmukharyamov@yahoo.comDzhordzhikiyaR K-Abdul’yanovI V-VagizovI I-SafarovaD F-AkhunovaS Yu-Kazan State Medical University, Kazan, RussiaInterregional Clinical and Diagnostic Center, Kazan, Russia1510201293571271628032016Copyright © 2012, Mukharyamov M.N., Dzhordzhikiya R.K., Abdul’yanov I.V., Vagizov I.I., Safarova D.F., Akhunova S.Y.2012Aim. To evaluate to effectiveness and safety of the functional technique of measuring the length neo-chords during reconstructive operations on the mitral valve for degenerative mitral regurgitation. Methods. The study included 34 patients, in whom the method of chord prosthesis with polytetrafluoroethylene sutures was used for correction of the anterior and/or posterior mitral valve leaflet prolapse. In order to determine the length of the chords a technique of functional hydraulic tests with a sliding suture knot was used by pressure infusion of a cold isotonic sodium chloride solution into the left ventricle until optimal geometry and competence of the valve leaflets was achieved. Results. No perioperative deaths were registered. The average postoperative length of hospital stay was 10±3.1 days. In 97% of the cases this technique made it possible to obtain immediate satisfactory hemodynamic results of the reconstruction. In long-term follow-up (13 months) 1 (3%) patient was re-operated for severe mitral regurgitation that was associated with the detachment of a native anterior leaflet chord, which was discovered during the operation. The two neo-chords epithelialized, became macroscopically indistinguishable from the native chords, and could be identified by the knots on the atrial side of the leaflet, their integrity was not compromised. In all other cases long-term follow-up after the operation showed a satisfactory hemodynamic functionality of the mitral valve. 76% of the operated patients had postoperative echocardiographic examination performed in our center. In 42% of patients there was no insufficiency, 44% of the patients had 1st degree regurgitation, in 14% of patients the regurgitation was classified as 1-2 degree with no signs of left atrium volume overload, left ventricular dysfunction or symptoms of heart failure. Conclusion. The functional technique for determining the length of neo-chords is an effective and safe method that makes it possible to successfully perform reconstructive operations for degenerative mitral regurgitation.neo-chordmitral valve leaflet prolapsedegenerative mitral regurgitationmitral valve plastypolytetrafluoroethylene suturesнеохордапролапс створки митрального клапанадегенеративная митральная недостаточностьпластика митрального клапананить из политетрафторэтилена[Бокерия Л.А., Гудкова Р.Г. Сердечно-сосудистая хирургия. - М.: Изд-во НЦССХ им. А.Н. Бакулева РАМН, 2008. - 181 с.][Караськов А.М., Горбатых Л.В., Семёнов И.И. и др. Пути оптимизации кардиохирургической службы Сибирского федерального округа (2002-2007 гг.) // Патол. кровообр. и кардиохир. - 2009. - №1. - С. 3-5.][Национальные рекомендации по ведению, диагностике и лечению клапанных пороков сердца. - М.: Изд-во НЦССХ им. А.Н. Бакулева, 2009 - 356 с.][Adams D.H., Rosenhek R., Falk V. Degenerative mitral valve regurgitation: best practice revolution // Eur. Heart J. - 2010. - Vol. 31, N 16. - P. 1959-1966.][Calafiore A.M. Choice of artificial chordae length according to echocardiographic criteria // Ann. Thorac. Surg. - 2006. - Vol. 81. - P. 375-377.][David T.E., Omran A., Armstrong S. et al. A comparison of outcomes of mitral valve repair for degenerative disease with posterior, anterior, and bileaflet prolapsed // J. Thorac. Cardiovasc. Surg. - 2005. - Vol. 130. - P. 1242-1249.][Minatoya K., Okabayashi H., Shimada H. et al. Pathologic aspects of polytetrafluoroethylene sutures in human heart // Ann. Thorac. Surg. - 1996. - Vol. 61. - P. 883-876.][Oppell U.O., Mohr F.W. Chordal replacement for both minimally invasive and conventional mitral valve surgery using premeasured Gore-Tex loops // Ann. Thorac. Surg. - 2000. - Vol. 70, N 6. - P. 2166-2168.][Perier P. A new paradigm for the repair of posterior leaflet prolapse: respect rather than resect // Oper. Techn. Thorac. Cardiovasc. Surg. - 2005. - Vol. 10. - P. 180-193.][Rankin J.S., Orozco R.E., Rodgers T.L. et al. «Adjustable» artificial chordal replacement for repair of mitral valve prolapse // Ann. Thorac. Surg. - 2006. - Vol. 81. - P. 1526-1528.]