Minimally Invasive Portal

The present a case of a 55 year old male with known mitral valve insufficiency. By transesophageal echo the patient was found to have a ruptured chordae on the P2 segment of the posterior leaflet of the mitral valve. He underwent minimally invasive mitral valve repair via right thoracotomy.

UPDATE: A follow-up video has been added that demonstrates how to manufacture the chordae system. Through a port-access incision, this video demonstrates a technique for placing an echocardiographically pre-measured chordae system to properly suspend the whole of the prolapsed anterior leaflet to its normal level of coaptation.

Hemodynamically stable patients with an undiagnosed pericardial effusion are well suited for a thoracoscopic window. When pericardial, pleural, or pulmonary pathology co-exist and require diagnosis or therapy, a thoracoscopic approach is ideal.

Ligation of the thoracic duct is indicated in any patient with a traumatic or iatrogenic chylothorax who has not responded to a brief trial of conservative management such as a low-fat diet, medium-chain triglycerides, total parenteral nutrition, and/or octreotide.