Posterior Chordal Cutting in Rheumatic Mitral Regurgitation Due to Hypomobility of the Posterior Leaflet Antonio Maria Calafiore, MD, Ibrahim Farah,

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Posterior Chordal Cutting in Rheumatic Mitral Regurgitation Due to Hypomobility of the Posterior Leaflet Antonio Maria Calafiore, MD, Ibrahim Farah, MD, Angela Lorena Iaco, MD, Saeed Al Ahmari, MD, Hussein Al Amri, MD, Michele Di Mauro, MD The Annals of Thoracic Surgery Volume 92, Issue 4, Pages 1532-1533 (October 2011) DOI: 10.1016/j.athoracsur.2011.05.043 Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Transesophageal echocardiography. The anterior leaflet reaches the plane of the mitral annulus without reaching the left atrium. The posterior leaflet, which is tethered due to chordal retraction, has a limited movement. The Annals of Thoracic Surgery 2011 92, 1532-1533DOI: (10.1016/j.athoracsur.2011.05.043) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) The short and thickened chords limit the movement of the posterior leaflet. (B) An artificial chord is implanted on the papillary muscle and it is tied 10 mm over the maximum extension of the free border of the leaflet, obtained after having pushed it by means of a nerve hook. (C) The native primary and secondary chords are then cut. The Annals of Thoracic Surgery 2011 92, 1532-1533DOI: (10.1016/j.athoracsur.2011.05.043) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Transesophageal echocardiography. The posterior leaflet is fixed in a vertical position and offers a huge surface of coaptation to the anterior leaflet. The Annals of Thoracic Surgery 2011 92, 1532-1533DOI: (10.1016/j.athoracsur.2011.05.043) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions