Complex Mitral Repair of a Calcified Posterior Leaflet Through an Upper Mini Sternotomy 

In this video, Dr. Vince Gaudiani demonstrates how to perform a complex repair of a calcified posterior leaflet. He first cannulated the femoral vein, then performed an upper mini sternotomy before conducting aortic cannulation. He then administered antegrade cardioplegia and placed a right superior pulmonary vein vent.   

The roof of the left atrium was then opened, and stay sutures were placed to optimize the view. Before assessing the valve, all the annuloplasty sutures were placed.  

Upon assessment of the valve, the posterior leaflet was calcified. P2 had a lot of calcium at the base, was bowed, and had some torn chords. P1 was separated from P2, and the leaflet was removed from the annulus. A shark-tooth rongeur was used to remove the calcium from under the leaflet and from the annulus.   

The P2 leaflet was reattached to the annulus with pledgeted 2.0 interrupted sutures and then attached to P3 and P1 to repair the commissures. The 16 mm Onyx Chord-X premade chord system was used to place three sets of chords from the posteromedial papillary muscle to the posterior leaflets. An annuloplasty ring was then placed, and the valve was tested and found to be an excellent repair. 

Disclaimer

The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.