Robot assisted mitral valve repair with neochords, leaflet plasty and annuloplasty along with closure of PFO and left atrial appendage

This is an example of a patient who presented with mitral regurgitation that had progressed over the years as she was followed by her cardiologist. She had annular dilatation along with a poor zone of coaptation and a billowing anterior leaflet.The regurgitation was central and moderate to severe on pre-op TEE. Intra-operatively she was found to have asymmetric billowing medial segment of A2 with myxomatous changes apparent. She had an isolated ruptured chord at center of A2 and the medial anterior chords where markedly elongated. Three sets of GoreTex chords were placed to the corresponding PM papillary muscle. Care was taken to avoid SAM (systolic anterior motion), by performing a minimal reduction in annular size with a flexible band. A small cleft at the site of the ruptured chord was easily closed with a horizontal mattress stitch. There was excellent lockdown of the valve and no regurgitation on saline testing or post-op TEE. An incidental PFO was closed and the left atrial appendage was closed for a history of remote paroxysmal a-fib and presence of left atrial enlargement.