Mitral Valve Repair and Repair of an Anomalous Right Coronary Artery Through an Upper Mini Sternotomy 

This patient in this video was a 55-year-old female who underwent a mitral valve repair for prolapse and had an anomalous right coronary artery as well.  Dr. Vince Gaudiani begins this video by explaining the condition of anomalous right coronary artery and when it poses risks and when it does not.   

Dr. Gaudiani began the surgery by cannulating the femoral vein then performing an upper mini sternotomy.  He then placed a right superior pulmonary vein vent and cannulated the superior vena cava (SVC) and aorta with antegrade del Nido cardioplegia. Next, a sling was placed around the aorta.   

The right atrium was then opened, and the left atrium was entered through the fossa ovalis, where stay sutures were placed to optimize the view.  

To repair the mitral regurgitation, two clefts on either side of p2 were found.  Sixteen mm Onyx Chord-X leaflets were used to repair the posterior leaflet, and the clefts were closed before an annuloplasty ring was placed.   

The right coronary artery (RCA) was then addressed, and a CT and angiogram showed the slit of the RCA. The RCA was dissected from outside the aorta, and the proximal portion was transfixed as it entered the aorta and was then cut.  A 4 mm punch was used, and the RCA was anastomosed back onto the aorta over the right coronary cusp.  

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