Effects of Edge-to-Edge Repair on Chordal Tension of Prolapsed Mitral Valve

Edge-to-edge repair (ETER) was introduced to correct mitral valve (MV) regurgitation and has demonstrated efficacy in a spectrum of MV diseases [1], especially MV prolapse. This technique changes MV geometric configuration by suturing the anterior and posterior leaflets at central or commissural edges (depending on lesion), and consequently alters MV mechanics. MV prolapse is the most common heart valve abnormality in the United States. It is mainly caused by chordal rupture or elongation in which imbalanced chordal lengths protrude MV anterior and/or posterior leaflets. Chordal repair or leaflet resection are common surgical procedures in an open heart surgery. ETER is also effective in treatment of MV prolapse and preferred because of potential percutaneous application of the similar procedure. However, ETER restore leaflet coaptation from a prolapsed MV and may alter leaflet stress and chordal tension distribution. Our hypothesis is that ETER changes leaflet and chord special configuration of a prolapsed MV and thus chordal tensions as compared with normal and prolapsed MVs. The aim of the current study was to investigate tensions of marginal, strut chordae of anterior leaflet, and of marginal, intermediate chordae of posterior leaflet during systole before and after ETER on the MV with a prolapsed posterior leaflet. Hypothesis is tested by comparison of chordal tension change.