Congenital absence of posteromedial papillary muscle and anterior mitral leaflet chordae: The use of three-dimensional echocardiography and approach in.

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Congenital absence of posteromedial papillary muscle and anterior mitral leaflet chordae: The use of three-dimensional echocardiography and approach in complex pediatric mitral valve disease Christopher W. Baird, MD, A. Resai Bengur, MD, Andrew Bensky, MD, Larry T. Watts, MD The Journal of Thoracic and Cardiovascular Surgery Volume 139, Issue 4, Pages e75-e77 (April 2010) DOI: 10.1016/j.jtcvs.2009.03.006 Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Preoperative and postoperative transthoracic echocardiograms (TTE). A, Preoperative TTE with short-axis view from the ventricle in late diastole. Primary disease is shown, including a prolapsed anterior leaflet, a cleft in the anterior leaflet, secondary chordae tethering the posterior leaflet, and a rudimentary posteriomedial commisure. B, Postoperative TTE, short-axis view from the ventricle, showing the areas of repair. These include the commissuroplasties and annuloplasties, closure of anterior leaflet cleft, and division of secondary chordae attached to the posterior leaflet. C, Postoperative TTE, short-axis view from ventricle, showing anterior and posterior leaflet apposition without leaflet prolapse. D, Postoperative TTE, 4-chamber view, showing the neochorda from the posteriomedial papillary muscle remnant attaching to the anterior mitral valve leaflet. The Journal of Thoracic and Cardiovascular Surgery 2010 139, e75-e77DOI: (10.1016/j.jtcvs.2009.03.006) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Schematic of postoperative repair representing posteromedial and anterolateral comissuroplasties, figure-of-8 suture posteromedial and anterolateral annuloplasties, anterior leaflet cleft closure, division of secondary chordae restricting the posterior leaflet, and creation of a neochorda from the rudimentary posteromedial papillary muscle to the free edge of the anterior leaflet. AL, Anterior leaflet; PL, posterior leaflet; RA, right atrium; RV, right ventricle; LA, left atrium; LV, left ventricle. The Journal of Thoracic and Cardiovascular Surgery 2010 139, e75-e77DOI: (10.1016/j.jtcvs.2009.03.006) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions