PREOPERATIVE DIAGNOSIS: Severe Mitral Regurgitation
OPERATION: Mitral Valve Repair (Repair of Fibroelastic Deficiency; P2 Resection; Limited Sliding Plasty to Lower Overall Height of Remaining P2 Segment; True Size 28 Carpentier Edwards Physio Ring Annuloplasty); Closure of PFO; Exploration of Tricuspid Valve
SURGEON: David Adams, M.D.
INDICATIONS FOR SURGERY: 50-year-old woman with a long history of mitral valve prolapse, basically asymptomatic and has severe regurgitation. She was referred for elective surgery.
OPERATIVE PROCEDURE: A small skin incision hemi-sternotomy was performed. We began by exposing the mitral valve through Sondergaard's groove. Valve analysis revealed complicated fibroelastic deficiency. She had a ballooning giant P2 segment with marked thickening and minimal P1 tissue. She also had a somewhat thickened anterior leaflet. We began by performing a limited resection of P2. We then undermined the remaining P2 segments we planned to keep and performed a limited detachment/reattachment to shorten the overall height of the remaining segments. A vertical plication was also done. The leaflets were reapproximated with a 5-0 Prolene suture. A true size 28 Carpentier-Edwards Physio-ring was now selected. It was tied securely to the annulus. The valve had an excellent line of symmetry, a normal saline test and a normal ink test.
POSTOPERATIVE ANALYSIS: The post-bypass transesophageal echo revealed absent residual regurgitation.
Department of Cardiothoracic Surgery | Mount Sinai Medical Center | 1190 Fifth Avenue | New York, NY 10029 | 212-659-6820
