PREOPERATIVE DIAGNOSIS: Mitral Regurgitation

OPERATION: Complex Barlow Mitral Valve Repair (Size 36 Physio Ring Annuloplasty; Posterior Leaflet Resection with Commissure to Commissure Sliding Plasty, Gap Closure P2, P3; Correction of Anterior Leaflet Prolapse with Posterior Leaflet Flip Technique x 2; Gap Closure P2, P3)

SURGEON: David Adams, M.D.

INDICATIONS FOR SURGERY: This patient is a 73-year-old man with a history of mitral valve prolapse that has progressed to moderate to severe degree of insufficiency. He was referred for elective surgical intervention.

OPERATIVE PROCEDURE: The mitral valve was exposed through Sondergaard's groove. Valve analysis revealed complex Barlow's disease. There was a giant prolapse and excess tissue of both leaflets with ruptured chordae involving P2 and A2. I began by performing a resection of P2, saving leaflet segments with basal chordae in the ventricle. The posterior leaflet was now detached commissure to commissure. Vertical and horizontal compression was done. The leaflet edges were reapproximated with running interrupted Prolene sutures. The gap was closed between P1 and P3. We now corrected the anterior leaflet prolapse with 2 transfers of the P2 segments with tissue and basal chordae. A true size 36 Carpentier-Edwards Physio ring was implanted. The valve had an excellent line of symmetry and normal saline and ink test.

POSTOPERATIVE ANALYSIS: The post-bypass transesophageal echo revealed absent residual regurgitation.