ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Mechanical and physiological effects of indentational chords in sliding leaflet plasty technique: an ex vivo bovine heart model
Murat Tavlaşoğlu1, Ahmet Barış Durukan2, Mustafa Kürklüoğlu3, Hasan Alper Gürbüz2, Adem Güler4, Faruk Cingöz4, Bilgehan Savaş Öz4, Mehmet Arslan4
1Department of Cardiovascular Surgery, Diyarbakır Military Hospital, Diyarbakır, Turkey
2Department of Cardiovascular Surgery, Memorial Ankara Hostipal, Ankara, Turkey
3Department of Cardiovascular Surgery, Children’s National Heart Institute, Children’s National Medical Center, Washington DC, USA
4Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Ankara, Turkey
DOI : 10.5606/tgkdc.dergisi.2015.10282
Background: In this model of mitral valve repair simulation, we aim to analyze the mechanical and physiological effects of primary chords supporting the intentionally closed indentations in sliding leaflet plasty of the posterior leaflet of mitral valve.

Methods: Posterior quadrangular resection and sliding leaflet techniques were simulated in 24 cases in bovine heart. In all cases, posterior mitral leaflet indentations were closed with 5-0 silk sutures. The indentational chords were left untouched in group 1 (n=12), and were resected in group 2 (n=12). The coaptation lines between anterior and posterior leaflets were assessed in both groups. Presence of tethering chords in posterior leaflet was investigated while the mitral valve competence was tested under the pressure of 170 cmH2O (125 mmHg).

Results: While coaptation lines were asymmetric in all cases in group 1, no asymmetric coaptation line was detected in group 2 (p<0.001). It was determined that the asymmetric coaptation lines in group 1 were caused by the primary chords supporting the intentionally closed indentations during the procedure.

Conclusion: It can be suggested that after closing the indentations, the primary chords supporting these indentations function as secondary chords which restrain leaflet mobilization in sliding posterior leaflet technique.

Keywords : Bovine heart model; mitral indentation; mitral valve repair simulations; primary chord
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