Modified commissural plication in mitral valve repair for commissural prolapse.

Commissural plication is a simple and useful technique for commissural prolapse repair. However, simple plication may not work when the diseased commissure is thick or calcified. In such cases, we incise the commissure towards the annulus and bring two separate parts of the commissural leaflet back together by sewing the atrial sides of each part. This modified commissural plication technique is still very simple and effective even for thick or calcified commissural lesions because it minimizes tension on the commissural sutures.