{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T03:03:58Z","timestamp":1781665438326,"version":"3.54.5"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,6,5]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Carpentier's techniques for degenerative posterior mitral leaflet prolapse have been established with excellent long\u2010term results reported. However, residual mitral regurgitation (\n              <jats:styled-content style=\"fixed-case\">MR<\/jats:styled-content>\n              ) occasionally occurs even after a straightforward repair, though the involved mechanisms are not fully understood. We sought to identify specific preoperative echocardiographic findings associated with residual\n              <jats:styled-content style=\"fixed-case\">MR<\/jats:styled-content>\n              after a posterior mitral leaflet repair.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We retrospectively studied 117 consecutive patients who underwent a primary mitral valve repair for isolated posterior mitral leaflet prolapse including a preoperative 3\u2010dimensional transesophageal echocardiography examination. Twelve had residual\n              <jats:styled-content style=\"fixed-case\">MR<\/jats:styled-content>\n              after the initial repair, of whom 7 required a corrective second pump run, 4 underwent conversion to mitral valve replacement, and 1 developed moderate\n              <jats:styled-content style=\"fixed-case\">MR<\/jats:styled-content>\n              within 1\u00a0month. Their preoperative parameters were compared with those of 105 patients who had an uneventful mitral valve repair. There were no hospital deaths. Multivariate analysis identified preoperative anterior mitral leaflet tethering angle as a significant predictor for residual\n              <jats:styled-content style=\"fixed-case\">MR<\/jats:styled-content>\n              (odds ratio, 6.82; 95% confidence interval, 1.8\u201333.8;\n              <jats:italic>P<\/jats:italic>\n              =0.0049). Receiver operator characteristics curve analysis revealed a cut\u2010off value of 24.3\u00b0 (area under the curve, 0.77), indicating that anterior mitral leaflet angle predicts residual\n              <jats:styled-content style=\"fixed-case\">MR<\/jats:styled-content>\n              . In multivariate regression analysis, smaller anteroposterior mitral annular diameter (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) and lower left ventricular ejection fraction (\n              <jats:italic>P<\/jats:italic>\n              =0.002) were significantly associated with higher anterior mitral leaflet angle, whereas left ventricular and left atrial dimension had no significant correlation.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Anterior mitral leaflet tethering in cases of posterior mitral leaflet prolapse has an adverse impact on early results following mitral valve repair. The findings of preoperative 3\u2010dimensional transesophageal echocardiography are important for consideration of a careful surgical strategy.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.117.008495","type":"journal-article","created":{"date-parts":[[2018,6,1]],"date-time":"2018-06-01T09:20:47Z","timestamp":1527844847000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Residual Mitral Regurgitation After Repair for Posterior Leaflet Prolapse\u2014Importance of Preoperative Anterior Leaflet Tethering"],"prefix":"10.1161","volume":"7","author":[{"given":"Taichi","family":"Sakaguchi","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuyuki","family":"Kagiyama","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Washington University, St. Louis, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Misako","family":"Toki","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, The Sakakibara Heart Institute of Okayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arudo","family":"Hiraoka","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihiro","family":"Hayashida","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Sakakibara Heart Institute of Okayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshinori","family":"Totsugawa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kentaro","family":"Tamura","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Genta","family":"Chikazawa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidenori","family":"Yoshitaka","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiyoshi","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Sakakibara Heart Institute of Okayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.104.suppl_1.I-8"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2011.12.054"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.10.098"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/021849230501300315"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2005.11.032"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2016.08.088"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehq222"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11748-013-0341-2"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)39144-5"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.796151"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.649236"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.084178"},{"key":"e_1_3_3_14_2","first-page":"e120","article-title":"2014 AHA\/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines","volume":"130","author":"Nishimura RA","year":"2014","unstructured":"Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD; ACC\/AHA Task Force Members . 2014 AHA\/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130:e120.","journal-title":"Circulation"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0894-7317(03)00335-3"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/echo.13135"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(98)00756-5"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2011.11.014"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2007.03.078"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1186\/1476-7120-5-25"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2009.12.070"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-16-0435"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1093\/icvts\/ivv119"},{"key":"e_1_3_3_24_2","first-page":"385","article-title":"Does left atrial enlargement contribute to mitral leaflet tethering in patients with functional mitral regurgitation? Proposed role of atriogenic leaflet tethering","volume":"23","author":"Silbiger JJ","year":"2014","unstructured":"Silbiger JJ. Does left atrial enlargement contribute to mitral leaflet tethering in patients with functional mitral regurgitation? Proposed role of atriogenic leaflet tethering. J Heart Valve Dis. 2014;23:385\u2013386.","journal-title":"J Heart Valve Dis"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.117.008495","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T10:57:45Z","timestamp":1715597865000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.117.008495"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,6,5]]},"references-count":23,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2018,6,5]]}},"alternative-id":["10.1161\/JAHA.117.008495"],"URL":"https:\/\/doi.org\/10.1161\/jaha.117.008495","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,6,5]]},"assertion":[{"value":"2017-12-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-05-03","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-06-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e008495"}}