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Updated: Jan 12, 2026

Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
Minimally Invasive Valve-Sparing Approach for Mitral Leaflet Perforation
Alexandra Murillo-Solera1, Oscar Holmvard1, Ahmet Bilgili1
1Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida, USA.
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.
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