Surgical management of the anterior leaflet in mitral valve repair: the legacy of Professor Alain Carpentier

The perfect example is when there is a ruptured AL marginal chord, along with a “seagull sign”, which is a plication of the body of the AL, in relation to a near secondary chord at the adequate height. In such cases, the identification of this secondary chord may allow, once trimmed of the AL, its use in supporting the prolapsed free edge. The technique itself is quite simple: the tip of the chord usually has a small portion of the leaflet body. A 5/0 or a 4/0 monofilament mattress suture is enough to hold the transposed chord and attach it to the ventricular aspect of the AL free edge at the identified area. This type of suture may seem fragile, but it is not and secures excellent long-term results (5)