During preoperative transesophageal echocardiography, a line was drawn between the base of the anterior and posterior mitral leaflet to measure the distance between the head of the posterior papillary muscle and the plane at the co-optation of the leaflets; this measured the artificial chordal length. During surgery, 4-0 Gore- Tex was passed through the fibrous tip of the papillary muscle with a pledget and was fixed with a loose knot. Two tight reverse knots were made for every millimeter of 4-0 Gore-Tex that was required. The needles were passed through the edge of the anterior leaflet at the prolapsing portion,.
