Case history using Memo 3D Rechord
Mr Inderpaul Birdi. BMed-Sci (Hon) BM BS FRCS. (CTh) MCh.
The Essex Cardiothoracic Centre, Basildon Hospital. Basildon and Thurrock University Hospitals NHS Foundation
Trust. Nethermayne, Basildon
Essex SS16 5NL - United Kingdoms
A 70 year old man was referred to the Keyhole Heart clinic with a history of shortness of breath on exertion.
Investigations revealed severe mitral valve regurgitation due to bileaflet valve prolapse (Barlow’s valve). Coronary angiography revealed normal coronary arteries. Detailed review of his mitral valve pathology indicated that sternotomy was the preferred approach in this case as complex reconstruction of both leaflets would be required.
The patient was placed on cardiopulmonary bypass and the mitral valve was approached via the left atrial free wall after cardioplegic arrest was established.
The annulus was dilated. Elongation of chords to all three segments of each leaflet was recognized and in addition, there was rupture of marginal chords to P3. The extent of prolapse meant that there was no clear reference point that could be used to indicate “normal” chordal length. We therefore chose to exploit the Memo 3D Rechord ring with its unique chordal guiding system.
Mitral valve repair
Eight pledgeted Gore-Tex chords were placed in appropriate portions of the fibrous heads of each papillary muscle.
Four of these were then inserted into the free margins of the posterior mitral valve leaflet.
A 32mm Memo 3D Rechord was secured in place with interrupted Ethibond sutures and the posterior leaflet chords were inserted through the reference loops of the chordal guiding system. These chords were then tied to length before releasing them from the chordal guiding system on the Memo ring.
The remaining four Gore-Tex chords were then inserted into the anterior leaflet margins and were tied by hand using the now corrected posterior leaflet as a reference point for each of the anterior leaflet segments (A1, A2, and A3).
Saline testing revealed excellent repair with good coaptation across all segments of the mitral valve.
The patient was weaned from cardiopulmonary bypass and TOE confirmed exemplary repair with no trace of mitral valve regurgitation.
The patient has made a full recovery from surgery without complications.