Repair of Recurrent Congenital Mitral Insufficiency Using Folding Plasty

(Department of Cardiovascular Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan and Department of Pediatric Cardiac Surgery, Saitama Medical University International Medical Center*, Hidaka, Japan)

Kiyoshi Koizumi Toshihiko Ueda Shinichi Taguchi
Yoshito Inoue Ichiro Kashima Toshiyuki Katogi*
A 13-year-old girl with congenital mitral incompetence had undergone valvoplasty using the De Vega technique at age 5. The patient was referred by the pediatric department due to recurrence of mitral incompetence. Transesophageal echocardiography indicated regurgitation from A2 and P3, mild mitral leaflet tethering and left ventricular dilatation. Intraoperative findings showed valvular agenesis of the posterior leaflet around P3. No leaflet prolapse was observed at A2, but leaflet P2 had fallen to the left ventricular side compared with leaflet A2, thereby inducing regurgitation due to coaptation gap. In a procedure similar to folding plasty, leaflet P3 was folded down and sutured to the annulus extending up to the posteromedial commissure. This technique not only controlled regurgitation at P3 but also improved the coaptation between A2 and P2. Annuloplasty was conducted using a 28-mm Physio-ring. Folding plasty may be an effective surgical option for patients with congenital mitral incompetence because a broad valve orifice area can be maintained because there is no need for annular plication.
@Jpn. J. Cardiovasc. Surg. 37: 209-211 (2008)