JACC Case Rep. 2025 Oct 29;30(34):105585. doi: 10.1016/j.jaccas.2025.105585.

ABSTRACT

OBJECTIVE: To describe the case of a 52-year-old man who developed severe mitral regurgitation 4 years after undergoing aortic valve replacement, maze procedure, and mitral vegetation removal during surgery for infective endocarditis; the mitral regurgitation was due to a perforation of the anterior mitral leaflet (A2) identified on transthoracic echocardiography.

KEY STEPS: Key procedural steps included: 1) right minithoracotomy access; 2) adhesiolysis and wedge resection of pleural perforations; 3) leaflet perforation repair with bovine pericardial patch; and 4) annuloplasty ring implantation.

POTENTIAL PITFALLS: Patch repair can fail if the patch is undersized, poorly positioned, or not well integrated, leading to residual regurgitation or early breakdown. Anterior leaflet repairs also carry a risk of systolic anterior motion, and prior surgery may complicate access owing to adhesions.

TAKE-HOME MESSAGES: Mitral valve repair using a pericardial patch is a reasonable option for anterior leaflet perforation, even in complex reoperative settings. Early recognition and a tailored, minimally invasive approach may offer favorable outcomes in selected patients.

PMID:41173632 | PMC:PMC12665858 | DOI:10.1016/j.jaccas.2025.105585