Triplo_yt_2.mp4 (302.15 MB)

Triple-Orifice Repair of Severe Mitral Regurgitation With Multiple Jets

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posted on 14.04.2020 by Carlo Fucci, Giuseppe De Cicco, Stefano Benussi

A 41-year-old male patient presented with sinus rhythm, PAPS 44 mm Hg, left atrial dimention 45 mm, LVEF 70%, severe mitral regurgitation with mechanism, A2-P2 prolapse, and A3-P3 prolapse. A triple-orifice repair (TOR) with annuloplasty was performed. At intraoperative TEE, the three orifices showed a mean total valve area of 2.9 cm2 with no residual regurgitation and no sign of valve stenosis (gradient 4.0 mm Hg). At 12-month follow-up, TTE showed no recurrence of MI and stress TTE showed persistent effective valve function at peak exercise. The patient showed significant NYHA functional class improvement (from III to I).

The TOR, which derives from the edge-to-edge technique (E2E) originally described by Alfieri et al in 1995 (1), allowed the correction of complex valve dysfunctions with an easy and quick procedure and reproducible results. After more than a decade of experience in this setting of cardiac surgery, this video shows, once again, that the three orifices correct MI with multiple-site jets, enhance diastolic transmitral flow without restriction, with disappearance of minor jets thanks to the use of the mitral ring. The application of a complete ring was intended to stabilize the repair but also to reduce undue stress on the anchoring stitches, as shown by some experimental or computational studies about the E2E techniques (1-3). Medium-term of results of such MR techniques showed stable and effective MV function during stressful hemodynamic conditions. In conclusion, this video indicates that the TOVR technique is effective in correcting complex Barlow mitral valves with multiple jets.


  1. Fucci C, Sandrelli L, Pardini A, Torracca L, Ferrari M, Alfieri O. Improved results with mitral valve repair using new surgical techniques. Eur J Cardiothorac Surg. 1995;9:621–626.
  2. Nielsen SL, Timek TA, Lai DT, Daughters GT, Liang D, Hasenkam JM. Edge-to-edge mitral repair: tension of approximating suture and leaflet deformation during acute ischemic mitral regurgitation in ovine heart. Circulation. 2001;104(2 Suppl 1):I29–35.
  3. Dal Pan F, Donzella G, Fucci C, Schreiber M. Structural effects of an innovative surgical technique to repair heart valve defects. J Biomech. 2005;38:2460–2471.



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