Combined reconstruction with leaflet extension plasty (Fig. 23)
This technique is especially used when patients with combined defects, whether of congenital or post-rheumatic origin, are subjected to reconstruction . In addition to commissurotomy and mobilization of the leaflet by detaching adhesive and shortened chordae, fenestration of chorda bundles, or longitudinal splitting of the papillary muscle, the regurgitation component should also be eliminated by unilateral or bilateral leaflet extension plasty in order to achieve a sufficiently large orifice as well as complete closure of the valve (Fig. 23.1–8).