Failure of a bioprosthetic mitral valve due to attachment of a residual chorda.

A 74 year old woman with postrheumatic mitral valve disease presented initially at the age of 67 years with severe mitral regurgitation secondary to ruptured chordae of the posterior cusp. The mitral valve was replaced by a 29 mm Hancock heterograft, a satisfactory fit within the annulus being obtained. The prosthesis was sewn into position with multiple simple interrupted 2/0 Mersilene sutures. Her postoperative recovery was complicated by the Guillain-Barre syndrome, but was otherwise uneventful. She presented again with mitral incompetence seven years after the initial operation. Cardiac catheter studies confirmed the presence of mitral incompetence and elective revision surgery was undertaken. At operation there was no evidence of auricular appendage thrombus but two abnormalities of the mitral valve prosthesis were identified. One of the leaflets adjacent to the anterolateral commissural area had become detached from its stent connections and the stent had become attached to a residual chorda. The valve was excised and replaced with a 31 mm Carpentier-Edwards bioprosthesis. The subsequent postoperative recovery was uneventful.