Neonatal Mitral and Tricuspid Valve Repair for In Utero Papillary Muscle Rupture Petros V. Anagnostopoulos, MD, Nelson Alphonso, MD, Lars Nölke, MD, Lisa.

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Neonatal Mitral and Tricuspid Valve Repair for In Utero Papillary Muscle Rupture Petros V. Anagnostopoulos, MD, Nelson Alphonso, MD, Lars Nölke, MD, Lisa K. Hornberger, MD, Gary W. Raff, MD, Anthony Azakie, MD, Tom R. Karl, MD The Annals of Thoracic Surgery Volume 83, Issue 4, Pages 1458-1462 (April 2007) DOI: 10.1016/j.athoracsur.2006.10.077 Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Valve insufficiency secondary to a ruptured papillary muscle (arrow). The Annals of Thoracic Surgery 2007 83, 1458-1462DOI: (10.1016/j.athoracsur.2006.10.077) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 The leaflet free edge is supported with neochordae of 6-0 expanded polytetrafluoroethylene, sutured to the base of a papillary muscle, but not in the infarcted area. The length is adjusted to neutralize the prolapse. The Annals of Thoracic Surgery 2007 83, 1458-1462DOI: (10.1016/j.athoracsur.2006.10.077) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 The tricuspid valve annulus us stabilized using a modified de Vega technique with a 5-0 expanded polytetrafluoroethylene suture. The ends of the suture are passed through the wall of the right atrium and controlled with a tourniquet. The annulus can be adjusted after separation from cardiopulmonary bypass using transesophageal control. (SVC = superior vena cava.) The Annals of Thoracic Surgery 2007 83, 1458-1462DOI: (10.1016/j.athoracsur.2006.10.077) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions