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Posterior cusp enlargement in mitral valve reconstructive surgery for restrictive valve insufficiency: Case report

Stojanović Ivan (Institut za kardiovaskularne bolesti 'Dedinje', Beograd)
Jovović Ljiljana (Institut za kardiovaskularne bolesti 'Dedinje', Beograd)
Vuković Milan (Institut za kardiovaskularne bolesti 'Dedinje', Beograd)
Trkulja Ljiljana (Institut za kardiovaskularne bolesti 'Dedinje', Beograd)
Bojović Željko (Institut za kardiovaskularne bolesti 'Dedinje', Beograd)

Introduction According to Carpentier classification, group III of mitral insufficiency is caused by the restrictive motion of the mitral valve. A rheumatic process and a coronary disease are the main causes. It is very important to examine the valve precisely, to define deformities and aetiology in order to make such a valve functional. In rheumatic disease, fibrosis and degeneration deform the entire mitral apparatus. A surgical principle is to re-establish mobility and pliability of the apparatus taking care of the functional anatomy at the same time. Cusp enlargement, chordal mobilization and ring remodeling are just some of the numerous surgical techniques that could be performed in these patients. Case outlineA 55-year old female patient was admitted to hospital with severe mitral regurgitaion. She belonged to NYHA, functional stage 2. Echocardiography revealed that both cusps, mostly posterior, were of reduced size and mobility, resulting in grade 3 regurgitation. We performed posterior cusp enlargement by using autologous pericardium treated in 0.6% of glutaraldehyde solution. Annulus remodeling was done using size 27 flexible Duran ring. Control echocardiography found trivial regurgitation. The patient was discharged on 12th postoperative day in sinus rhythm. Conclusion Surgical reconstruction of the rheumatic mitral valve back to the functional state is a demanding procedure, which, however, provides certain benefit for the successfully treated patient.

Keywords: mitral, reconstruction, restrictive, rheumatic, patch