Endoscopic Repair of Partial Endocardial Cushion Defect With Mitral Valve Repair

Partial endocardial cushion defects, presenting as an ostium primum atrial septal defect associated with a cleft in the anterior mitral valve leaflet, traditionally requires a conventional median sternotomy. While sternotomy provides excellent exposure, it is associated with significant surgical trauma, prolonged recovery times, and less desirable cosmetic outcomes.

This video presentation demonstrates a sophisticated, totally endoscopic surgical technique designed to treat this congenital anomaly. By shifting to a minimally invasive approach, this technique achieved excellent visualization and structural repair, resulting in a smooth postoperative course for the patient.

This video features a totally endoscopic repair of a partial endocardial cushion defect with concomitant mitral valve repair in an adult patient who presented with progressive exertional dyspnea and severe mitral regurgitation. Preoperative transthoracic and transesophageal echocardiography confirmed an ostium primum defect, a cleft anterior mitral leaflet, severe mitral regurgitation, and preserved ventricular function.

The procedure was performed through a right endoscopic approach using peripheral cardiopulmonary bypass established via femoral arterial and venous cannulation. Following aortic cross-clamping and cardioplegic arrest, the right atrium was opened, and detailed inspection revealed an ostium primum defect and a cleft in the anterior mitral leaflet with annular dilatation.

The margins of the atrial septal defect were carefully delineated, and closure was achieved using bovine pericardial patch secured with continuous polypropylene sutures while preserving the integrity of the conduction tissue and atrioventricular valve apparatus.

The interatrial groove was opened, the cleft was meticulously closed using interrupted polypropylene sutures, and an annuloplasty band was inserted to restore leaflet coaptation and valve competency. Saline testing and intraoperative assessment confirmed satisfactory valve function without stenosis and regurgitation.

After deairing and the restoration of cardiac activity, transesophageal echocardiography demonstrated complete closure of the septal defect, the absence of residual shunting, and trivial mitral regurgitation. A postoperative electrocardiogram (ECG) showed no complete heart block.

Key technical aspects highlighted in this video include optimal endoscopic exposure of the atrioventricular valves, secure patch reconstruction of the atrial septum, and strategies to avoid injury to the conduction system, including the precise identification and closure of the mitral cleft and the insertion of an annuloplasty band. The endoscopic approach provides excellent visualization, facilitates complex intracardiac repair, and offers the benefits of reduced surgical trauma, faster recovery, and superior cosmetic results. Notably, the patient remained free of complete heart block and was discharged with only trivial mitral regurgitation, demonstrating the safety and efficacy of the endoscopic technique for this congenital anomaly and offering superior cosmetic results.

This case demonstrates that an endoscopic repair of a partial endocardial cushion defect with mitral valve repair is a safe, effective, and reproducible minimally invasive alternative to conventional sternotomy in appropriately selected patients.

References

1. Castillo-Sang M, Penaranda J. Totally Endoscopic ASD Closure With Tricuspid Valve Repair. CTSNet. April 2025. doi:10.25373/ctsnet.28806776.
2. Yemets G. Totally Endoscopic Partial AVSD Repair in an Adult. CTSNet. Published October 20, 2025. doi:10.25373/ctsnet.30402133.
3. Flores Flores O. Endoscopic Cone Repair in an Adult Patient With Ebstein Anomaly. CTSNet. February 11, 2026. doi:10.25373/ctsnet.31320481.

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