# Posterior Leaflet Overlay Patch Reinforcement for Mitral Valve Posterior Tethering: The Elbow Patch Repair

## TL;DR

A new surgical technique called the 'elbow patch repair' is introduced to address challenges in mitral valve repair, particularly in patients with atrial functional mitral regurgitation.

## Contribution

The elbow patch repair is a novel surgical technique using an autologous pericardium overlay patch to reinforce the posterior mitral valve leaflet.

## Key findings

- The elbow patch repair effectively managed posterior mitral valve leaflet deficiency in a patient with atrial functional mitral regurgitation.
- The technique restored the coaptation surface and was combined with annuloplasty and neochordae placement.
- The approach is proposed as a solution for leaflet shortage in select cases of Carpentier Class IIIb.

## Abstract

The scarcity of leaflet tissue and restricted systolic motion remain challenges in mitral valve repair. In addition to functional or secondary mitral regurgitation, atrial functional mitral regurgitation, characterized by chronic atrial fibrillation, preserved left ventricular function, and atriogenic leaflet tethering, exacerbates leaflet scarcity, complicating mitral valve repair. To address this, we introduce the “elbow patch repair,” a novel technique using an autologous pericardium overlay patch to reinforce the posterior mitral valve leaflet. A 65-year-old male patient with chronic atrial fibrillation and severe mitral regurgitation consistent with atrial functional mitral regurgitation underwent the “elbow patch repair” combined with annuloplasty and neochordae placement. This approach effectively managed posterior mitral valve leaflet deficiency and restored the coaptation surface. The “elbow patch repair” offers a straightforward and effective solution for leaflet shortage in atrial functional mitral regurgitation and select cases of Carpentier Class IIIb. Further studies are needed to assess its long-term durability.