How-to-do-it Posterior transposition of anterior leaflet for complete chordal preservation

A method of complete chordal preservation based on posterior transposition of anterior leaflet is presented. The anterior leaflet and chordae are completely detached from the annulus and reimplanted as a large patch under the posterior leaflet. The excess tissue without chordae is excised and the remnant with all the chordae is plicated by sutures used to implant the prosthesis. The posterior leaflet is left intact. The technique is safe and reproducible and no complications related with the procedure have been observed at mid-term follow-up. These results have led to a wider application of total chordal preservation during mitral valve replacement. # 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.