The Role of Palmaris Muscle Tendon in Mitral Valve Annulus Reconstruction: A Novel Technique for Mitral Valve Repair

Authors

  • Jeffrey H. Shuhaiber
  • Hans H. Shuhaiber
  • Gregory A. Dumanian

DOI:

https://doi.org/10.1532/HSF98.20041051

Abstract

Background: Autogenous tissue for heart valve repair is limited to pericardium and fascia lata. Prosthetic annuloplasty rings have limitations and are expensive. No previous cadaveric study has documented autotransplantation of forearm tendons for mitral valve repair. The purposes of this anatomical study were (1) to determine the feasibility of using tendons for annular reconstruction during mitral valve repair (band or ring shape) and (2) to compare the metric dimensions and gross morphology with those of prosthetic rings.

Methods: The palmaris tendon (PM) (n = 7) was harvested from forearms of human cadavers and prepared in the dissecting room. The tendon was incorporated along the valve annulus. Surgery consisted of mitral valve annuloplasty performed with an undersized and a complete tendon.

Results: On gross handling PM tissue was morphologically resilient. Preparation and use of PM for annuloplasty were feasible. Anatomical reconstruction of the annulus with autogenous tissue using this tendon also was feasible. The annulus behaved as a flexible ring that allowed for improved atrioventricular continuity. Complete (n = 7) and partial (n = 7) annuloplasty rings were constructed. Metric dimensions were similar to those of prosthetic rings.

Conclusion: PM is a suitable novel autogenous tissue that can be harvested together with the radial artery and has direct relevance in ischemic mitral valve regurgitation. These tendons can be easily utilized to achieve results similar to those of pericardial reconstruction and prosthetic annuloplasty rings. The tissue is readily available from the patient, and no extra cost is incurred. Further chemical studies in the human subjects are warranted.

References

Ionescu MI, Ross DN, Wooler GH, Deac R, Ray D. 1970. Replacement of heart valves with autologous fascia lata: surgical technique. Br J Surg 57:437-42.nLam DS, Ng JS, Cheng GP, Li RT. 1998. Autogenous palmaris longus tendon as frontalis suspension material for ptosis correction in children. Am J Ophthalmol 126:109-15.nMcCarthy JG, ed. 1990. Plastic Surgery. Vol 1. Philadelphia: WB Saunders; 535-6. Schechtman H, Bader DL. 2002. Fatigue damage of human tendons. J Biomech 35:347-53.nBrand PW. 1961. Tendon grafting: illustrated by a new operation for intrinsic paralysis of the fingers. J Bone Joint Surg 43B:444-53.nChachques JC, Acar C, Latremouille C, et al. 1990. Absorbable rings for pediatric valvuloplasty: preliminary study. Circulation 82(suppl):IV82-8.nDeloche A, Jebara VA, Relland JY, et al. 1990. Valve repair with Carpentier techniques: the second decade. J Thorac Cardiovasc Surg 99:990-1001.nDickson JB, Major MD. 1986. The use of a pedal extensor tendon in frontalis suspension surgery. Ophthalmic Surg 17:581-3.nDietl CA, Benoit CH. 1995. Radial artery graft for coronary revascularization: technical considerations. Ann Thorac Surg 60:102-9.nEnriquez-Sarano M, Schaff HV, Frye RL. 2003. Mitral regurgitation: what causes the leakage is fundamental to the outcome of valve repair. Circulation 22;108:253-6.nEnriquez-Sarano M, Schaff HV, Orszulak TA, Takij AJ, Bailey KR, Frye RL. 1995. Valve repair improves the outcome of surgery for mitral regurgitation: a multivariate analysis. Circulation 91:1022-8.nFrater RW, Gabbay S, Shore D, Factor S, Strom J. 1983. Reproducible replacement of elongated or ruptured mitral valve chordae. Ann Thorac Surg 35:14-28.nGelberman RH, Vandeberg JS, Manske PR, Akeson WH. 1985. The early stages of flexor tendon healing: a morphologic study of the first fourteen days. J Hand Surg 10A:776-84.nGillinov AM, Wierup PN, Blackstone EH, et al. 2001. Is repair preferable to replacement for ischemic mitral regurgitation? J Thorac Cardiovasc Surg 122:1125-41.nGray H. 1918. Anatomy of the Human Body. Philadelphia: Lea & Febiger. Available at: http://www.bartleby.com/107.n

Published

2005-01-04

How to Cite

Shuhaiber, J. H., Shuhaiber, H. H., & Dumanian, G. A. (2005). The Role of Palmaris Muscle Tendon in Mitral Valve Annulus Reconstruction: A Novel Technique for Mitral Valve Repair. The Heart Surgery Forum, 7(5), E519-E522. https://doi.org/10.1532/HSF98.20041051

Issue

Section

Articles