Minimal access mitral valve repair in a patient with a right pneumonectomy for Scimitar syndrome

A 61-year old man known with chronic atrial fibrillation was referred to our unit via the multidisciplinary team meeting, with severe mitral regurgitation secondary to prolapse of anterior mitral leaflet. In 1968, he had undergone right pneumonectomy due to Scimitar syndrome. Dense adhesions due to previous interventions, such as thoracotomy, make it difficult to insert ports, and this is therefore considered a relative contraindication to port access approach to the mitral valve. The anatomical position of the heart in the mediastinum was completely distorted due to the shift of the mediastinum to the right following previous surgery. Our report illustrates the operative success that can be achieved in such complex situations. Computed tomography scanning and on table transoesophageal and transthoracic echocardiography were the tools used in conjunction to achieve the best possible approach. This case promotes the use of minimal access approach in the experienced hands so that such complex procedures can be carried out without any complication and yield good results.