Rheumatic Double Valve Repair Using Two Remodeling Annuloplasty Rings

Objectives

Cardiac valve repair is a recognized approach to achieve satisfactory long-term valve function and improved survival over replacement. Concomitant aortic and mitral valve repair has been associated with excellent freedom from recurrent insufficiency or valve related complications. This video illustrates an operative approach of combined rheumatic mitral valve repair and aortic valve repair involving double remodeling ring annuloplasty.

Methods

A 70-year-old man with NYHA class 3 congestive heart failure was found to have grade 3 aortic valve insufficiency, grade 2-3 mitral insufficiency with mild mitral stenosis, and an ejection fraction of 35%. Transesophageal echocardiography showed a trileaflet aortic valve with rheumatic nodular retraction plus retraction and thickening of the posterior mitral leaflet with good mobility of the anterior leaflet.

Results

Surgical correction included pericardial patch augmentation of the posterior mitral leaflet using glutaraldehyde-fixed autologous pericardium and rigid ring annuloplasty. Nodular retraction and minor leaflet calcification of the aortic valve were addressed using ultrasonic debridement, followed by implantation of a 3D aortic annuloplasty ring to complete the repair. Postoperative transesophageal echocardiography revealed excellent hemodynamic freedom from valvular regurgitation or stenosis.

Conclusion

Mitral valve repair techniques are well developed and allow for successful reconstruction in selected patients with rheumatic valvular disease. The use of an aortic annuloplasty ring may provide a simple option for enhancing the reparability of rheumatic aortic valve insufficiency.

This educational video was originally presented during the STSA 65th Annual Meeting. This content is published with the permission of the STSA. For more information on the STSA and its next Annual Meeting, please click here.