Butterfly Resection Is Safe and Avoids Systolic Anterior Motion in Posterior Leaflet Prolapse Repair

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Abstract

Background

Quadrangular resection is a standard repair technique for prolapsing posterior leaflet; however, systolic anterior motion (SAM) sometimes occurs. Butterfly resection combines a triangular resection from the prolapsing edge and a reverse triangular resection to the annulus to remove redundancy, reduce leaflet height without annular plication, and minimize SAM. We assessed short-term and midterm outcomes and mitral leaflet configuration after repair vs quadrangular resection.

Methods

Between 2002 and 2009, 53 patients underwent posterior leaflet resection with mitral annuloplasty, including quadrangular resection in 24 and butterfly resection in 29.

Results

The butterfly group had a significantly larger mean ring size (29.0 vs 27.8 mm, p = 0.04). SAM occurred in 2 patients in the quadrangular group and in none in the butterfly group. SAM completely resolved in 1 patient after inotropes were weaned, but the other needed a mitral valve replacement. Predischarge echocardiography showed the butterfly group had a significantly larger anterior leaflet/posterior leaflet ratio (3.05 vs 1.53, p < 0.01) and greater length from the coaptation point to the septum (2.91 vs 2.50 cm, p = 0.02) than the quadrangular group. Measurements at 3 months showed that the differences between the two groups persisted. During follow-up, no patients died or needed reoperation for recurrence. Moderate mitral regurgitation occurred in 1 in the quadrangular group.

Conclusions

Butterfly resection can be safely performed without SAM and is durable in midterm follow-up. By echocardiography, this technique reduces the height of the posterior leaflet and shifts the coaptation point further away from the septum.

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