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Complex Mitral Valve Repair In An Infant
Jenna Aziz, MS1, Anita Krishnan, MD2, Yves d'Udekem, MD2, Yue-Hin Loke, MD2, Karthik Ramakrishnan, MD3.
1Howard University College of Medicine, Washington, DC, USA, 2Children's National Hospital, Washington, DC, USA, 3Children’s National Hospital, Washington, DC, USA.

Objectives:Congenital mitral stenosis is a rare condition that sometimes requires surgical correction in the first year of life. In smaller infants, repair of complex congenital mitral stenosis is extremely challenging. This is related to small size, affecting access to and exposure of the mitral valve, as well as the lack of effective replacement options, should the initial repair fail. This video demonstrates the careful planning and execution required to repair complex congenital mitral stenosis.
Methods:
In this surgical video, we demonstrate our approach to a complex mitral valve repair in an infant who developed severe mitral stenosis. The salient features of the operation are aimed at facilitating adequate visualization of the entire mitral valve apparatus. Dissection of the Sondergaard’s interatrial groove, adequate left atriotomy, placement of circumferential annular stay sutures to bring the entire mitral valve into view, careful systematic assessment of the valve and slow, deliberate relief of the stenosis are all demonstrated in this video. In our patient, the subvalvar apparatus was thickened and fused giving a funnel shaped appearance of the open mitral valve. Repair required creation of multiple fenestrations in the subvalvar apparatus, splitting of the papillary muscles, and excision of subvalvar scar tissue removed.
Results: Intraoperative ECHO on coming off cardiopulmonary bypass showed a correction of the mitral stenosis. Postoperatively the patient continues to exhibit a stable repair at 3-month follow-up.
Conclusions: We present a video showing our successful approach to repairing severe mitral stenosis in an infant, thereby avoiding replacement of the valve.


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