A female patient with severe rheumatic mitral stenosis was classified under the Chinese pathological classification as type III /II.
Surgical Findings and Technique
Since the anterior commissural fibrosis was not severe, a small round knife was used for flexible shaving to preserve the anterior leaflet. The main strategy was to carefully separate the fused commissures while minimizing trauma to the leaflet tissue.
Additionally, the thickening of the anterior leaflet’s translucent zone was limited, with favorable bulging properties, indicating good residual leaflet pliability. Although the subvalvular fusion appeared extensive preoperatively, intraoperative inspection revealed clear boundary traces on the ventral and dorsal sides of the fused subvalvular tissues. This anatomical characteristic allowed for relatively smooth and effective release of the chordae and papillary muscles without encountering significant restrictive obstacles.
Suitability for the SCORE Procedure
Given the balanced features—acceptable leaflet quality, identifiable commissural fusion planes, and surgically amenable subvalvular adhesions—this case demonstrates excellent suitability for the SCORE procedure. The technique aims to restore maximal leaflet motion and achieve a competent, nonstenotic valve.
References
- Luo T, Meng X. Clinico-pathological classification of rheumatic mitral valve damage and surgical strategy. J Thorac Dis. 2021. 13(5): 2933-2941.
- FU J, LI Y, ZHANG H, et al. Outcomes of mitral valve repair compared with replacement for patients with rheumatic heart disease [J]. J Thorac Cardiovasc Surg, 2021, 162(1): 72-82 e7.
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