Brief Case Description


The patient is a 55 year-old male with new onset dyspnea on exertion. At physical examination, a systolic murmur of mitral regurgitation was audible at the apex.


Transthoracic echocardiography showed type II mitral dysfunction with posterior leaflet prolapse causing severe valve regurgitation. Left ventricular size and systolic function were normal. Echocardiography showed minimal tricuspid regurgitation. The right ventricle was normal in size and function.


The patient was referred for reconstructive mitral valve surgery. Preoperative cardiac catheterization showed normal coronaries.


Operative Procedure

 

Intraoperative Transesophageal Echocardiography (Voice of Dr. Mihaileanu)

 

Intraoperative transesophageal echocardiography (TEE) confirmed the diagnosis of posterior leaflet prolapse involving the P2 segment. Transgastric basal short axis view showed an interesting image suggestive of extra-leaflet tissue at the posteromedial commissural area.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mitral Valve Analysis (Voice of Pr. Carpentier)

 

Surgical valve analysis confirmed the diagnosis of fibroelastic deficiency with type II dysfunction and P2 prolapse (Left video). A more detailed analysis of posteromedial commissural area was performed to further assess TEE findings (Right video).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reconstructive Procedure (Voice of Pr. Carpentier)

 

Mitral valve reconstruction was performed with quadrangular resection of P2 segment, followed by annular plication and restoration of leaflet continuity. All these steps are shown in detail in the video.

 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Following the correction of P2 prolapse, annular sutures were placed around the mitral annulus. Finally, a remodeling ring annuloplasty was performed. The saline test showed excellent results with a symmetrical line of coaptation and no residual regurgitation.

 

Correct techniques of suture placement, ring sizing and implantation are shown in detail in the video.

 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Postbypass Transesophageal Echocardiography (Voice of Dr. Berrebi)

 

TEE showed a competent mitral valve with the restoration of a large surface of coaptation and no residual regurgitation.