A Novel Method of Leaflet Reconstruction After Triangular Resection for Posterior Mitral Valve Prolapse

Triangular leaflet resection to treat posterior mitral valve prolapse is expedient, sufficient, and durable in eliminating redundant myxomatous tissue and restoring normal leaflet coaptation. After triangular resection and suture reconstruction, mitral scallop height is decreased to a degree commensurate with the area of tissue resected. There are instances however, when excessive bulk of the remaining posterior leaflet may persist, predisposing to systolic anterior motion of the anterior mitral leaflet. We propose a novel adjunctive measure to normalize posterior leaflet height during suture reconstruction by ventricularizing what would otherwise have become the new tip of the posterior mitral leaflet. We have found that ventricularization of the leaflet edge during reconstruction obviates the need for excessive mitral leaflet resection, resulting in a symmetric and mobile neo-free edge that are capable of contributing to a robust zone of coaptation.