Endoscopic secondary chordae transfer and edge-to-edge repair for the treatment of asymmetric anterior leaflet prolapse.
Martina Giusti, Can Gollmann-Tepeköylü, Leo Pölzl et al.
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Case in brief
A 59-year-old patient with Barlow’s disease presented with severe mitral regurgitation from asymmetric anterior leaflet prolapse. Intraoperative assessment identified prolapse involving the A2M2 and A3 segments and elongated secondary chordae. Through a totally endoscopic right minithoracotomy, the valve was repaired with secondary chordae transfer, asymmetric edge-to-edge repair at the A2-P2 scallops, and ring annuloplasty. Intraoperative assessment showed satisfactory coaptation with trivial residual regurgitation. Postoperative echocardiography showed no residual mitral regurgitation or clinically significant mitral stenosis.
What made this case unusual
The repair addressed complex, asymmetric anterior leaflet prolapse in Barlow’s disease using a combination of secondary chordae transfer and asymmetric edge-to-edge repair, performed through a totally endoscopic approach.
Diagnostic / clinical pearl
In complex asymmetric anterior leaflet prolapse, intraoperative segmental assessment can guide a tailored repair combining chordal transfer, edge-to-edge repair, and annuloplasty.