By P. K. Ghosh (auth.), Probal K. Ghosh MD, MS, MCh, FRCSE, Felix Unger (eds.)
Attempts to reconstruct a number of components of the center begun even sooner than the start of open cardiac surgical procedure. by means of the overdue Nineteen Fifties and early 1960 s a number of closed and open strategies had already been defined. In that period, numerous surgeons in Europe and the Americas have been relatively triggered to advance numerous innovations of valve re development as a result of loss of appropriate valve prostheses and conduits that have turn into to be had for this reason. at the moment, a number of congenital lesions nonetheless defied definitive correction, and medical makes an attempt at left ventricular wall alternative had no longer but obtained lower than manner. A renaissance in numerous cardiac reconstructive strategies began in the beginning of the Eighties. because the difficulties in terms of valve prostheses turned extra normally preferred and the significance of chamber volumes and geometry (atrial or ventricular) used to be accorded due significance within the long term follow-up, there has been a resurgence of surgical makes an attempt at reconstruction in congenital and purchased cardiac lesions to be able to approximate the common country. even as numerous features of this reconstructive "discipline" grew to become obvious. First, cardiac reconstructive surgical procedure has remained a surgical "art" with a progressively expanding variety of cardiac surgeons.
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It is well recognized that complete closure of the cleft, as we initially did in our first patient, has the potential for producing acute mitral stenosis postoperatively [11,12]. On the other hand, in that particular patient, a partial closure of the cleft, as suggested by Lee et al.  would have resulted in an important residual mitral regurgitation. The valve was incompetent centrally, that is at the cleft site in the proximity of the free edge of the leaflet. Approximation of the cleft with sutures placed first at the base and then carried towards the central part of the valve would not have achieved an acceptable result without being complete.
Since the insufficiency of the valve was located at the cleft site centrally, only the part of the cleft close to the free edges of the leaflets was approximated with stitches. The rest of the cleft was left open, creating, as in the first patient, a triple-orifice mitral valve. Following this reconstruction, the valve appeared to be perfectly competent and certainly not stenotic due to the orifice between the center of the valve and the base of the cleft. This patient is very well 16 months postoperatively.
Group 2 Predominant incompetence (n = 2): both patients with incompetence had a dilated mitral anulus and a deficient posterior cusp. In addition, one of them had a cleft in the anterior cusp. Group 3 Miscellaneous (n = 1): this patient had a redundant mitral tissue attached to the ventricular aspect of the anterior mitral leaflet, producing subaortic stenosis. Of the ten patients, seven had coexisting abnormalities (Table 2), of whom five (all in group 1) had two or more of the components of the Shone complex.