[Mitral Valve Plasty for Complicated Lesions with Barlow-like Anterior Leaflet].

A 66 year-old male was admitted to our clinic suffering from dyspnea on effort. Cardio thoracic ratio (CTR) was 62%. Electrocardiogram showed atrial fibrillation. Echocardiogram showed severe mitral regurgitation (MR), Barlow like billowing and thickened A2 and A3, and loss of P2 and P3. Operation was performed through median sternotomy and right sided left atrial incision. Left atrial appendage was closed with running suture. Maze operation was done. Triangular resection of A2 and A3 was done. P2 and P3 were adhered to the left ventricular wall. First we cut the adhered posterior leaflet in a shape of inverted T. And the adhered leaflet was dissected from the left ventricle by the scissors. The detached annulus was mattress-sutured with a pledgetted suture. The leaflets were sutured together, then a new posterior leaflet was remade using mitral valve leaflet tissue and the shape became higher and round. Post operatively, MR was none, and posterior leaflet functioned well. Sinus rhythm was recovered. Eleven years later, no MR and sinus rhythm were shown.

[How to Repair the Bicuspid Aortic Valve Accompanying Regurgitation?]

We repaired the bicuspid aoric valve( BAV) with aortic regurgitation( AR) by bicuspidization. However, repaired fused cusp does not open full, and shows doming. Between 1997 and 2023 we repaired 30 BAV with AR. Mean Age was 44( 15-79) years old. Male gender was 26/30. Between 1997 and 2017, we repaired by triangular resection and cusp suspension or central plication and the commissural positions remained as it was, in 17 cases. Between 2018 and 2023, we repaired by triangular resection and aortic root remodeling to make the commissure angle 180 degree in 13 cases. One patient died because of compression occlusion of left main trunk by Schaefer's annulplasty suture post-operatively. Postoperative aortic valve pressure gradient was 12.2±5.4 mmHg in natural commissure position group, 14.7±6.8 mmHg in the 180 degree commissure position group( p=0.37). And in the 180 degree commissure position group, the fused cusp did not show doming. In the 180 degree commissure position group, the fused cusp did not show doming. However, trans aortic valve pressure gradient did not decrease. On the other hand, in the natural commissure group, the fused cusp showed doming. However, the valves well functioned up to 25 years without aortic stenosis.