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CUTTING THE SECOND ORDER CHORDS DURING MITRAL VALVE REPAIR
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  • Antonio Calafiore,
  • Sotirios Prapas,
  • Antonio Totaro,
  • Stefano Guarracini,
  • Marco Cargoni,
  • Kostas katsavrias,
  • Khalil Fattouch,
  • Michele Di Mauro
Antonio Calafiore
Department of Cardiovascular Diseases Gemelli Molise Campobasso Italy
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Sotirios Prapas
Errikos Ntynan Hospital Center Pathologiko
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Antonio Totaro
Department of Cardiovascular Diseases Gemelli Molise Campobasso Italy
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Stefano Guarracini
Department of Cardiology “Pierangeli” Hospital Pescara Italy
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Marco Cargoni
Ospedale Mazzini
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Kostas katsavrias
Errikos Ntynan Hospital Center Pathologiko
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Khalil Fattouch
Universita degli Studi di Palermo Dipartimento di Discipline Chirurgiche Oncologiche e Stomatologiche
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Michele Di Mauro
Universiteit Maastricht Cardiovascular Research Institute Maastricht
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Abstract

The chordae tendinae connect the papillary muscles to the mitral valve. While the first-order chordae serve to secure the leaflets to maintain valve closure and prevent mitral valve prolapse, the second-order chordae are believed that they play a role in maintaining normal LV size and geometry. The papillary muscles, from where the chordae tendinae originate, function as shock absorbers that compensate for the geometric changes of the left ventricular wall. The second-order chordae connect the PMs to both trigons under tension. The tension distributed towards the second-order chordae has been demonstrate to be more than three-fold that in the first-order counterpart. Cutting the second-order chordae puts all the tension on the first-order chordae, that can go closer to their rupture point. However, it has been experimentally demonstrated that the tension where the first-order chordae break is 6.8 N, by far higher than the maximal tension reached, that is 0.4 N. Even if the clinical reports have been favorable, the importance of cutting the second-order chordae to recover curvature of the anterior leaflet and increasing the coaptation length between the mitral leaflet has been slowly absorbed by the surgical world. Nevertheless, there are progressive demonstrations that chordal tethering affects the anterior leaflet not only in secondary, but also in primary mitral regurgitation, having a not negligeable role in the long-term outcome of mitral repair.