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Totally Endoscopic Mitral and Tricuspid Valve Repair, ASD With APVR Repair, and LAA Occlusion
Holubec T, Kaiser P, Eashid H, Salem R, Hecker F, Walther T. Totally Endoscopic Mitral and Tricuspid Valve Repair, ASD With APVR Repair, and LAA Occlusion. December 2025. doi:10.25373/ctsnet.30850772
This video is one of the top 10 entries from the 2025 Endoscopic Cardiac Surgeons Club Video Competition. More videos featuring these outstanding presentations will be showcased in the coming weeks.
The patient was a 70-year-old female who presented with New York Heart Association (NYHA) class II-III and a history of mitral and tricuspid regurgitation, long-standing persistent atrial fibrillation, and a history of circumflex stunting. Right heart catheterization showed a left-to-right shunt with Qp/Qs ratio of 2.3 and normal pulmonary vascular resistance (PVR). Preoperative imaging with computed tomography angiography (CTA) confirmed the anomalous pulmonary venous return (APVR) to the superior vena cava (SVC).
Percutaneous cannulation of the femoral vessels and the internal jugular vein was performed. Arrest was achieved with antegrade del Nido cardioplegia, using a Chitwood clamp. The anomalous pulmonary veins were controlled with silastic vessel loops, as were the superior and inferior vena cava. The right atrium was opened, and the ostia of the APVR were identified. The septal defect was enlarged, and the mitral valve was exposed through it. A 32 mm mitral ring was implanted through this incision. After this, a pericardial patch was used to baffle the two pulmonary veins into the atrial septal defect. A second pericardial patch was used to patch the SVC, and then the tricuspid valve was repaired using a band while the heart was beating. The right atriotomy was closed using the second pericardial patch. A left atrial appendage clip was applied through the transverse sinus. Postoperative transesophageal echocardiography (TEE) showed a good result and confirmed the redirection of the pulmonary veins draining into the left atrium.
The case had a total cross-clamp of 91 minutes. The patient was extubated five hours postoperatively and discharged home in good condition on postoperative day seven.
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