In vivo mitral valve repair for the transplanted donor heart in orthotopic heart transplantation

TL;DR

A patient with heart disease underwent heart transplant and required in vivo mitral valve repair to address unexpected regurgitation, resulting in successful recovery.

Contribution

Demonstrates a novel in vivo mitral valve repair technique during heart transplantation to address unexpected mitral regurgitation.

Findings

In vivo mitral annuloplasty using a prosthetic full ring successfully controlled regurgitation during heart transplant.

The patient was successfully weaned from cardiopulmonary bypass after the repair.

The patient remained free of mitral regurgitation and heart failure for over a year post-surgery.

Abstract

A 53-year-old woman with the dilated phase of hypertrophic cardiomyopathy underwent orthotopic heart transplantation. The donor heart was evaluated as normal preoperatively without mitral regurgitation or the left atrium dilation, transplanted using the modified bicaval technique. Although the heart beat satisfactorily after aortic declamping, massive mitral regurgitation was observed without any prolapse or annular dilation. Because of the difficulty in weaning from cardiopulmonary bypass, a second aortic cross-clamp was applied, and we detached the inferior vena cava and the right side of the left atrial anastomosis to approach the mitral valve, obtaining a satisfactory exposure. No abnormalities were observed in the mitral valve leaflets, annulus or subvalvular apparatus. Subsequent in vivo mitral annuloplasty using prosthetic full ring successfully controlled the regurgitation, and the patient was easily weaned from cardiopulmonary bypass. She discharged to home with good mitral valve and cardiac functions. And the patient has been doing well without any recurrence of MR or heart failure for over a year after surgery.

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