Endoscopic Anterior Leaflet Mitral Valve and Tricuspid Repair

MO001 

Case Video Submission 

SAMUEL MANCUSO (1), Diana Benea (1), marco diena (2)

(1) IRCCS Policlinico San Donato, SAN DONATO MILANESE, ITALY, (2) N/A, Italy

SAMUEL MANCUSO    -  Contact Me
IRCCS Policlinico San Donato

Diana Benea    -  Contact Me
IRCCS Policlinico San Donato

Marco Diena    -  Contact Me
N/A

Marco Diena    -  Contact Me
N/A

Objective: To present a case of a complex severe mitral valve regurgitation due to anterior leaflet prolapse and chordae tendinae rupture associated with tricuspid valve severe regurgitation due to annular dilation, treated with a minimally invasive totally 3D endoscopic technique.

Case Video Summary: A 68 years old patient presented with a worsening mild dyspnea (class NYHA II) and severe mitral and tricuspid regurgitation at trans-thoracic echocardiography. Trans-esophageal Echocardiogram confirmed the presence of severe anterior mitral prolapse, with first order chordae tendinae rupture of A2 scallop and associated flail. After a peripheral arterial and single venous double stage femoral cannulation, Del Nido anterior cardioplegia is infused, after clamping the aorta with Cygnet clamp through a 6 centimeters anterior-lateral incision in the III right intercostal space. Left atrium is opened and a venting line is positioned to keep the field clear. Valve inspection confirms transesophageal echocardiographic findings, associated with clearly thinned chordae tendinae of A3 scallop and concomitant mild prolapse. A 5/0 Goretex artificial chorda tendinea is positioned on the free edge of A2 and the damaged native chorda tendinea is resected; its length is adjusted comparing the length of the native ones. A 5/0 Goretex suture is positioned on the free edge of A3 where the secondary mild prolapse is found, in order to reduce the length of the free margin. A 34 complete prostetic mitral annulus is positioned and no resection of the anterior leaflet is performed. Left atrium is closed with a double running 4/0 Prolene suture and right atrium is opened to perform tricuspid valve annuloplasty with a flexible 32 prosthetic tricuspid ring, without encircling superior and inferior venae cavae. Intraoperative hydrodynamic test showed good continence after repair.

Conclusions: AL prolapse has been considered a more challenging problem and long-term results are not usually as favourable as those for PL prolapse. Many surgical techniques are currently available for the treatment of AL prolapse, involving not only the leaflets but also the subvalvular apparatus. Complex mitral valve repair is feasible even in totally minimally invasive endoscopic CT surgery, with optimal visualization of all the mitral valve apparatus. Even trcuspid valve repair is feasible with a simplified technique: single venous double stage cannulation without encircling venae cavae.

Minimally Invasive & Robotic Mitral Valve Repair