SCORE Procedure for Rheumatic Heart Disease in a Patient With a History of PBMV

A female patient with severe rheumatic mitral stenosis required surgical intervention. Intraoperative exploration revealed critical findings: the anterior commissure was densely fused with severe fibrous adherence, while the posterior leaflet body exhibited discrete calcific plaques. Notably, the subvalvular apparatus showed only mild chordal shortening, while the anterior leaflet’s clear zone maintained excellent bulging with preserved pliability. These anatomic factors favored a valve-repair strategy over replacement.

Surgical Technique

The SCORE procedure was performed using its four essential technical steps in a clear, sequential manner. The anterior commissural fusion was meticulously divided, followed by careful decalcification of the posterior leaflet plaques. Throughout these maneuvers, leaflet restriction was progressively and effectively relieved, with restoration of satisfactory mobility.

A critical component of this case was the management of iatrogenic complications. The patient had a prior history of percutaneous balloon mitral valvuloplasty and intraoperative inspection revealed potential leaflet tearing risks. Additionally, during removal of the posterior calcific deposits, a small leaflet injury occurred. Both types of lesions were successfully addressed using 6-0 polypropylene sutures, applied with precise, interrupted techniques to ensure hemostasis and anatomic restoration without distorting leaflet geometry or compromising coaptation.

Conclusion

This surgeons’ experience confirms that even in calcific variants with severe commissural fusion, the SCORE procedure can achieve excellent immediate hemodynamic results. The associated leaflet injuries were reliably manageable with fine suturing, thus extending the applicability of this repair technique in complex rheumatic pathology.

References

1. Luo T, Meng X. Clinico-pathological classification of rheumatic mitral valve damage and surgical strategy. J Thorac Dis. 2021. 13(5): 2933-2941.
2. 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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