{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T14:02:40Z","timestamp":1791813760299,"version":"4.3.4"},"reference-count":33,"publisher":"Texas Heart Institute Journal","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,11,1]]},"abstract":"<jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Mitral valve stenosis (MS) is the primary pathologic feature of rheumatic mitral valve disease, and the complex repair affects its clinical outcome. This study aimed to examine the efficacy of the 4-step commisuroplasty \u201cSCORe\u201d procedure by assessing changes in the mobility of mitral valve leaflets and its clinical effects.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>From September 1, 2018, to January 13, 2019, patients with MS who underwent mitral valve repair with the SCORe procedure in the study center were analyzed in this prospective study. Mitral valve structure was assessed by transthoracic echocardiography pre- and postoperatively as well as during follow-up.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>In total, 60 consecutive patients were examined. In 56 patients (93.3%), mitral valve orifice area (MVOA) was less than 1.5 cm<jats:sup>2<\/jats:sup>, and mean (SD) MVOA for the whole cohort was 1.20 (0.34) cm<jats:sup>2<\/jats:sup>. The mobility of the anterior leaflet was improved (<jats:italic>P<\/jats:italic> &lt; .001) during the cardiac cycle postsurgery, but that of the posterior leaflet was not (<jats:italic>P<\/jats:italic> = .591). The mean (SD) coaptation length was increased significantly from 6.69 (1.32) mm to 7.92 (1.24) mm (<jats:italic>P<\/jats:italic> &lt; .001) postoperatively. Mean (SD) MVOAs increased to 2.24 (0.38) cm2 postoperatively (<jats:italic>P<\/jats:italic> &lt; .001). During the 1-year follow-up, there were no deaths or reoperations. Follow-up echocardiography revealed minor or mild regurgitation in 98.3% of patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>These findings demonstrated that the SCORe procedure can effectively improve the mobility of mitral leaflets and enlarge the valve orifice area in patients with rheumatic MS in China, with minimal complications and promising results.<\/jats:p>\n<\/jats:sec>","DOI":"10.14503\/thij-21-7801","type":"journal-article","created":{"date-parts":[[2022,11,30]],"date-time":"2022-11-30T21:17:34Z","timestamp":1669843054000},"source":"Crossref","is-referenced-by-count":2,"title":["Short-Term Results on Leaflet Mobility in Patients Undergoing Rheumatic Mitral Valve Repair With an Efficient 4-Step Commissuroplasty Technique"],"prefix":"10.14503","volume":"49","author":[{"given":"Baiyu","family":"Tian","sequence":"first","affiliation":[{"name":"Cardiac Valve Center, Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Wu","sequence":"additional","affiliation":[{"name":"Cardiac Valve Center, Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Han","sequence":"additional","affiliation":[{"name":"Cardiac Valve Center, Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu","family":"Meng","sequence":"additional","affiliation":[{"name":"Cardiac Valve Center, Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuqing","family":"Jiao","sequence":"additional","affiliation":[{"name":"Cardiac Valve Center, Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiange","family":"Luo","sequence":"additional","affiliation":[{"name":"Cardiac Valve Center, Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuai","family":"Pang","sequence":"additional","affiliation":[{"name":"Center of Cardiovascular Surgery, The People's Hospital of Huaiyin Jinan, Jinan, Shandong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinguo","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"5628","reference":[{"issue":"1","key":"i1526-6702-49-6-e217801-b1","series-title":"N Engl J Med.","first-page":"e2","article-title":"Global burden of rheumatic heart disease","volume":"378","year":"2018","unstructured":"Johannsen\nRA,\n\n\nShroff\nGR.\n\n\nGlobal burden of rheumatic heart disease.\nN Engl J Med.2018;378(1):e2.\ndoi:10.1056\/NEJMc1714503"},{"key":"i1526-6702-49-6-e217801-b2","series-title":"Int J Cardiol.","first-page":"628","article-title":"Rheumatic heart disease in a developing country: incidence and trend (Monastir; Tunisia: 2000\u20132013)","volume":"228","year":"2017","unstructured":"Sriha Belguith\nA,\n\n\nKoubaa Abdelkafi\nA,\n\n\nEl Mhamdi\nS,\n\n.\n\nRheumatic heart disease in a developing country: incidence and trend (Monastir; Tunisia: 2000\u20132013).\nInt J Cardiol.2017;228:628\u2013632.\ndoi:10.1016\/j.ijcard.2016.11.249"},{"issue":"8","key":"i1526-6702-49-6-e217801-b3","series-title":"N Engl J Med.","first-page":"713","article-title":"Global, regional, and national burden of rheumatic heart disease, 1990\u20132015","volume":"377","year":"2017","unstructured":"Watkins\nDA,\n\n\nJohnson\nCO,\n\n\nColquhoun\nSM,\n\n\n.\nGlobal, regional, and national burden of rheumatic heart disease, 1990\u20132015.\nN Engl J Med.2017;377(8):713\u2013722.\ndoi:10.1056\/NEJMoa1603693"},{"issue":"1","key":"i1526-6702-49-6-e217801-b4","series-title":"J Surg Res.","first-page":"40","article-title":"Carpentier's reconstructive valve surgery","volume":"171","year":"2011","unstructured":"Mungara\nC,\n\n\nLozonschi\nL.\n\n\nCarpentier's reconstructive valve surgery.\nJ Surg Res.2011;171(1):40.\ndoi:10.1016\/j.jss.2011.05.013"},{"issue":"4","key":"i1526-6702-49-6-e217801-b5","series-title":"J Thorac Cardiovasc Surg.","first-page":"1432","article-title":"Mitral valve repair versus replacement for patients with preserved left ventricular function without heart failure symptoms","volume":"157","year":"2019","unstructured":"Hannan\nEL,\n\n\nSamadashvili\nZ,\n\n\nSmith\nCR,\n\n\n.\nMitral valve repair versus replacement for patients with preserved left ventricular function without heart failure symptoms.\nJ Thorac Cardiovasc Surg.2019;157(4):1432\u20131439.e2.\ndoi:10.1016\/j.jtcvs.2018.08.091"},{"issue":"3","key":"i1526-6702-49-6-e217801-b6","series-title":"Am J Cardiol.","first-page":"446","article-title":"Meta-analysis comparing mitral valve repair versus replacement for degenerative mitral regurgitation across all ages","volume":"123","year":"2019","unstructured":"Jung\nJC,\n\n\nJang\nMJ,\n\n\nHwang\nHY.\n\n\nMeta-analysis comparing mitral valve repair versus replacement for degenerative mitral regurgitation across all ages.\nAm J Cardiol.2019;123(3):446\u2013453.\ndoi:10.1016\/j.amjcard.2018.10.024"},{"issue":"2","key":"i1526-6702-49-6-e217801-b7","series-title":"Curr Cardiol Rev.","first-page":"157","article-title":"Long-term outcomes of mitral valve repair versus replacement for degenerative disease: a systematic review","volume":"11","year":"2015","unstructured":"McNeely\nCA,\n\n\nVassileva\nCM.\n\n\nLong-term outcomes of mitral valve repair versus replacement for degenerative disease: a systematic review.\nCurr Cardiol Rev.2015;11(2):157\u2013162.\ndoi:10.2174\/1573403X10666140827093650"},{"issue":"2","key":"i1526-6702-49-6-e217801-b8","series-title":"Tex Heart Inst J","first-page":"163","article-title":"Is rheumatic mitral valve repair still a feasible alternative? Indications, technique, and results","volume":"40","year":"2013","unstructured":"Bakir\nI,\n\n\nOnan\nB,\n\n\nOnan\nIS,\n\n\nGul\nM,\n\n\nUslu\nN.\n\n\nIs rheumatic mitral valve repair still a feasible alternative? Indications, technique, and results.\nTex Heart Inst J.\n2013;40(2):163\u2013169."},{"issue":"5","key":"i1526-6702-49-6-e217801-b9","series-title":"Heart Surg Forum.","first-page":"E352","article-title":"Early and midterm outcomes of rheumatic mitral valve repair","volume":"21","year":"2018","unstructured":"Salem\nA,\n\n\nAbdelgawad\nAME,\n\n\nElshemy\nA.\n\n\nEarly and midterm outcomes of rheumatic mitral valve repair.\nHeart Surg Forum.2018;21(5):E352\u2013E358.\ndoi:10.1532\/hsf.1978"},{"issue":"9","key":"i1526-6702-49-6-e217801-b10","series-title":"J Thorac Dis.","first-page":"3138","article-title":"Features of rheumatic mitral valves and a grading system to identify suitable repair cases in China","volume":"9","year":"2017","unstructured":"Luo\nT,\n\n\nHan\nJ,\n\n\nMeng\nX.\n\n\nFeatures of rheumatic mitral valves and a grading system to identify suitable repair cases in China.\nJ Thorac Dis.2017;9(9):3138\u20133147.\ndoi:10.21037\/jtd.2017.08.121"},{"issue":"6","key":"i1526-6702-49-6-e217801-b11","series-title":"Heart Lung Circ.","first-page":"940","article-title":"Commissuroplasty as a main operative technique in rheumatic mitral valve repair: surgical experiences and mid-term results","volume":"29","year":"2020","unstructured":"Luo\nT,\n\n\nMeng\nX,\n\n\nYan\nZ,\n\n\nZhan\nY,\n\n\nPopal\nMS.\n\n\nCommissuroplasty as a main operative technique in rheumatic mitral valve repair: surgical experiences and mid-term results.\nHeart Lung Circ.2020;29(6):940\u2013948.\ndoi:10.1016\/j.hlc.2019.05.189"},{"issue":"25","key":"i1526-6702-49-6-e217801-b12","series-title":"Circulation.","first-page":"e1159","article-title":"2017 AHA\/ACC Focused Update of the 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 Clinical Practice Guidelines","volume":"135","year":"2017","unstructured":"Nishimura\nRA,\n\n\nOtto\nCM,\n\n\nBonow\nRO,\n\n\n.\n2017 AHA\/ACC Focused Update of the 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 Clinical Practice Guidelines.\nCirculation.2017;135(25):e1159\u2013e1195.\ndoi:10.1161\/CIR.0000000000000503"},{"issue":"3","key":"i1526-6702-49-6-e217801-b13","series-title":"Chinese Hospital Management.","first-page":"53","article-title":"Establishment and improvement of cardiac post-operation follow-up database","volume":"35","year":"2015","unstructured":"Yu-Qing\nJ,\n\n\nJian-Gang\nW,\n\n\nHai-Bo\nZ.\n\n\nEstablishment and improvement of cardiac post-operation follow-up database.\nChinese Hospital Management.2015;35(3):53\u201355."},{"issue":"10","key":"i1526-6702-49-6-e217801-b14","series-title":"Heart.","first-page":"796","article-title":"Repair for rheumatic mitral valve disease. The controversy goes on!","volume":"104","year":"2018","unstructured":"Antunes\nMJ.\n\n\nRepair for rheumatic mitral valve disease. The controversy goes on!\n\nHeart.\n\n2018;104(10):796\u2013797.\ndoi:10.1136\/heartjnl-2017-312674"},{"issue":"12 suppl 1","key":"i1526-6702-49-6-e217801-b15","series-title":"Circulation.","first-page":"I12","article-title":"Long-term (29 years) results of reconstructive surgery in rheumatic mitral valve insufficiency","volume":"104","year":"2001","unstructured":"Chauvaud\nS,\n\n\nFuzellier\nJF,\n\n\nBerrebi\nA,\n\n\nDeloche\nA,\n\n\nFabiani\nJN,\n\n\nCarpentier\nA.\n\n\nLong-term (29 years) results of reconstructive surgery in rheumatic mitral valve insufficiency.\nCirculation.2001;104(12 suppl 1):I12\u2013I15.\ndoi:10.1161\/hc37t1.094707"},{"issue":"4","key":"i1526-6702-49-6-e217801-b16","series-title":"Rev Bras Cir Cardiovasc.","first-page":"485","article-title":"Mitral valve repair in rheumatic patients with mitral insufficiency: twenty years of techniques and results","volume":"24","year":"2009","unstructured":"Pomerantzeff\nPM,\n\n\nBrand\u00e3o\nCM,\n\n\nLeite Filho\nOA,\n\n.\n\nMitral valve repair in rheumatic patients with mitral insufficiency: twenty years of techniques and results.\nRev Bras Cir Cardiovasc.2009;24(4):485\u2013489.\ndoi:10.1590\/s0102-76382009000500009"},{"issue":"2","key":"i1526-6702-49-6-e217801-b17","series-title":"Heart Asia.","first-page":"e010916","article-title":"Outcomes after mitral valve surgery for rheumatic heart disease","volume":"9","year":"2017","unstructured":"Russell\nEA,\n\n\nWalsh\nWF,\n\n\nReid\nCM,\n\n\n.\nOutcomes after mitral valve surgery for rheumatic heart disease.\nHeart Asia.2017;9(2):e010916.\ndoi:10.1136\/heartasia-2017-010916"},{"issue":"6","key":"i1526-6702-49-6-e217801-b18","series-title":"Asian Cardiovasc Thorac Ann.","first-page":"658","article-title":"Mitral valve repair for rheumatic mitral regurgitation: mid-term results","volume":"23","year":"2015","unstructured":"Waikittipong\nS.\n\n\nMitral valve repair for rheumatic mitral regurgitation: mid-term results.\nAsian Cardiovasc Thorac Ann.2015;23(6):658\u2013664.\ndoi:10.1177\/0218492315576282"},{"key":"i1526-6702-49-6-e217801-b19","series-title":"Glob Cardiol Sci Pract.","first-page":"9","article-title":"Challenges in rheumatic valvular disease: surgical strategies for mitral valve preservation","volume":"2015","year":"2015","unstructured":"Antunes\nMJ.\n\n\nChallenges in rheumatic valvular disease: surgical strategies for mitral valve preservation.\nGlob Cardiol Sci Pract.2015;2015:9.\ndoi:10.5339\/gcsp.2015.9"},{"key":"i1526-6702-49-6-e217801-b20","series-title":"Multimed Man Cardiothorac Surg.","first-page":"mmt020","article-title":"Repair of rheumatic mitral stenosis with bicommissural release, anterior leaflet augmentation and oversized annuloplasty","volume":"2014","year":"2014","unstructured":"Chan\nPG,\n\n\nHayanga\nAJ,\n\n\nBadhwar\nV.\n\n\nRepair of rheumatic mitral stenosis with bicommissural release, anterior leaflet augmentation and oversized annuloplasty.\nMultimed Man Cardiothorac Surg.2014;2014:mmt020.\ndoi:10.1093\/mmcts\/mmt020"},{"issue":"1","key":"i1526-6702-49-6-e217801-b21","series-title":"Tex Heart Inst J.","first-page":"8","article-title":"Mitral valve repair in a predominantly rheumatic population. Long-term results","volume":"28","year":"2001","unstructured":"Choudhary\nSK,\n\n\nTalwar\nS,\n\n\nDubey\nB,\n\n\nChopra\nA,\n\n\nSaxena\nA,\n\n\nKumar\nAS.\n\n\nMitral valve repair in a predominantly rheumatic population. Long-term results.\nTex Heart Inst J.2001;28(1):8\u201315."},{"issue":"6","key":"i1526-6702-49-6-e217801-b22","series-title":"Ann Thorac Surg","first-page":"1930","article-title":"Anterior mitral leaflet length: predictor for mitral valve repair in a rheumatic population","volume":"90","year":"2010","unstructured":"Gupta\nA,\n\n\nGharde\nP,\n\n\nKumar\nAS.\n\n\nAnterior mitral leaflet length: predictor for mitral valve repair in a rheumatic population.\nAnn Thorac Surg2010;90(6):1930\u20131933.\ndoi:10.1016\/j.athoracsur.2010.07.035"},{"key":"i1526-6702-49-6-e217801-b23","series-title":"Multimed Man Cardiothorac Surg.","article-title":"Bileaflet pericardial patch repair for rheumatic mitral valve disease","volume":"2018","year":"2018","unstructured":"Bissessar\nD,\n\n\nTom\u0161i\u010d\nA,\n\n\nvan Brakel\nT,\n\n\nKlautz\nR,\n\n\nPalmen\nM.\n\n\nBileaflet pericardial patch repair for rheumatic mitral valve disease.\nMultimed Man Cardiothorac Surg.2018;2018: 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mitral valve.\nMultimed Man Cardiothorac Surg.2012;2012:mms015.doi:10.1093\/mmcts\/mms015"},{"issue":"3","key":"i1526-6702-49-6-e217801-b26","series-title":"J Thorac Cardiovasc Surg.","first-page":"771","article-title":"Comparative long-term results of mitral valve repair in adults with chronic rheumatic disease and degenerative disease: is repair for \u201cburnt-out\u201d rheumatic disease still inferior to repair for degenerative disease in the current era?","volume":"149","year":"2015","unstructured":"Dillon\nJ,\n\n\nYakub\nMA,\n\n\nKong\nPK,\n\n\nRamli\nMF,\n\n\nJaffar\nN,\n\n\nGaffar\nIF.\n\n\nComparative long-term results of mitral valve repair in adults with chronic rheumatic disease and degenerative disease: is repair for \u201cburnt-out\u201d rheumatic disease still inferior to repair for degenerative disease in the current era?\n\nJ Thorac Cardiovasc Surg.\n\n2015;149(3):771\u2013777;\ndiscussion 777\u2013779. doi:10.1016\/j.jtcvs.2014.08.066"},{"issue":"suppl 8","key":"i1526-6702-49-6-e217801-b27","series-title":"J Med Assoc Thai.","first-page":"S51","article-title":"Rheumatic mitral valve repair: experience of 221 cases from Central Chest Institute of Thailand","volume":"95","year":"2012","unstructured":"Chotivatanapong\nT,\n\n\nLerdsomboon\nP,\n\n\nSungkahapong\nV.\n\n\nRheumatic mitral valve repair: experience of 221 cases from Central Chest Institute of Thailand.\nJ Med Assoc Thai.2012;95(suppl 8):S51\u2013S57."},{"issue":"5","key":"i1526-6702-49-6-e217801-b28","series-title":"J Cardiovasc Surg (Torino).","first-page":"617","article-title":"Structural analysis of the mitral valve in rheumatic and degenerative mitral valve diseases: implications for annuloplasty selection","volume":"60","year":"2019","unstructured":"Li\nY,\n\n\nZhang\nH,\n\n\nZhang\nH,\n\n\n.\nStructural analysis of the mitral valve in rheumatic and degenerative mitral valve diseases: implications for annuloplasty selection.\nJ Cardiovasc Surg (Torino).2019;60(5):617\u2013623.\ndoi:10.23736\/S0021-9509.19.10814-2"},{"issue":"17","key":"i1526-6702-49-6-e217801-b29","series-title":"Circulation.","first-page":"1934","article-title":"Combined mitral and tricuspid valve repair in rheumatic valve disease: fewer reoperations with prosthetic ring annuloplasty","volume":"121","year":"2010","unstructured":"Bernal\nJM,\n\n\nPont\u00f3n\nA,\n\n\nDiaz\nB,\n\n\n.\nCombined mitral and tricuspid valve repair in rheumatic valve disease: fewer reoperations with prosthetic ring annuloplasty.\nCirculation.2010;121(17):1934\u20131940.\ndoi:10.1161\/CIRCULATIONAHA.109.894873"},{"issue":"1","key":"i1526-6702-49-6-e217801-b30","series-title":"J Thorac Cardiovasc Surg.","first-page":"247","article-title":"Echocardiographic evaluation of mitral durability following valve repair in rheumatic mitral valve disease: impact of Maze procedure","volume":"147","year":"2014","unstructured":"Kim\nGS,\n\n\nLee\nCH,\n\n\nKim\nJB,\n\n\n.\nEchocardiographic evaluation of mitral durability following valve repair in rheumatic mitral valve disease: impact of Maze procedure.\nJ Thorac Cardiovasc Surg.2014;147(1):247\u2013253.\ndoi:10.1016\/j.jtcvs.2012.10.007."},{"issue":"36","key":"i1526-6702-49-6-e217801-b31","series-title":"Eur Heart J.","first-page":"2739","article-title":"2017 ESC\/EACTS guidelines for the management of valvular heart disease","volume":"38","year":"2017","unstructured":"Baumgartner\nH,\n\n\nFalk\nV,\n\n\nBax\nJJ,\n\n;\nESC Scientific Document Group.\n\n2017 ESC\/EACTS guidelines for the management of valvular heart disease.\nEur Heart J.2017;38(36):2739\u20132791.\ndoi:10.1093\/eurheartj\/ehx391"},{"issue":"10","key":"i1526-6702-49-6-e217801-b32","series-title":"Heart.","first-page":"841","article-title":"Clinical outcomes in 1731 patients undergoing mitral valve surgery for rheumatic valve disease","volume":"104","year":"2018","unstructured":"Kim\nWK,\n\n\nKim\nHJ,\n\n\nKim\nJB,\n\n\n.\nClinical outcomes in 1731 patients undergoing mitral valve surgery for rheumatic valve disease.\nHeart.2018;104(10):841\u2013848.\ndoi:10.1136\/heartjnl-2017-312249"},{"issue":"5","key":"i1526-6702-49-6-e217801-b33","series-title":"Eur J Cardiothorac Surg.","first-page":"1039","article-title":"Long-term outcomes after surgery for rheumatic mitral valve disease: valve repair versus mechanical valve replacement","volume":"37","year":"2010","unstructured":"Kim\nJB,\n\n\nKim\nHJ,\n\n\nMoon\nDH,\n\n\n.\nLong-term outcomes after surgery for rheumatic mitral valve disease: valve repair versus mechanical valve replacement.\nEur J Cardiothorac Surg.2010;37(5):1039\u20131046.\ndoi:10.1016\/j.ejcts.2009.11.019"}],"container-title":["Texas Heart Institute 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