The correct answer is:

Surgical chord replacement + Annuloplasty

The echo shows a patient with myxomatous mitral Valve Prolaps (M.Barlow) who had severe mitral regurgitation. He then underwent mitral valve repair with an annuloplasty ring. But he also had artificial chords (neo-chords) implanted.

Mitral valve replacement usually involves resection of the diseased segment of the mitral valve (i.e., quadrangular resection). In contrast, Chordal replacement is a „non-resection technique “ where artificial chords are placed between the papillary muscles and the free edge of prolapsing segments. This technique can be applied in numerous forms and morphologies of mitral valve disease. In addition, Leaflet mobility and the geometry of the annulus are preserved.

On the echo, you will find the following findings: 1) typical characteristics of artificial material (polytetrafluoroethylene) and 2) a bright echo at the tip of the papillary muscle. 3) annuloplasty ring.

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Yours,
Thomas Binder and the 123sonography team