Repairing the Mitral Valve Without Touching the Mitral Valve – A Novel Technique

Abstract

A 44-year-old gentleman presented with severe ischemic cardiomyopathy and mitral regurgitation post-inferior myocardial infarction. Echocardiography and magnetic resonance imaging revealed a dilated left ventricle with a large left ventricular aneurysm (9.3x9.5cm) and associated thrombus. Severe mitral regurgitation due to leaflet tethering and a left ventricular ejection fraction of 25% were also seen. The patient underwent successful aneurysmectomy with patch repair and papillary muscle approximation. Following initial weaning from cardiopulmonary bypass, six days of postoperative temporary VA-ECMO support were required. The patient was subsequently discharged on postoperative day sixteen with improved cardiac function (LVEF of 45%) and minimal residual mitral regurgitation, highlighting the efficacy of geometric restoration in addressing such mitral regurgitation, avoiding intervention on the mitral valve itself.