A Rare Case of Iatrogenic Left Atrial Roof Injury by a Guidewire During Robotic Mitral Valvuloplasty

Minimally invasive cardiac surgery enhanced by the daVinci robotic system offers benefits such as reduced morbidity and superior visualization. However, complications like unexpected bleeding may require conversion to median sternotomy, necessitating careful intraoperative manipulation. We report a rare case of left atrial roof injury during robotic mitral valvuloplasty in a 61-year-old woman with severe mitral regurgitation. Cardiopulmonary bypass was established via femoral and jugular vein cannulation. Upon initiation, bleeding was identified from a wire perforation at the left atrial roof. Hemostasis was successfully achieved using a 3-0 Prolene mattress suture. Mitral valve repair and patent foramen ovale closure were completed uneventfully, and the patient was discharged on postoperative day 8. This case highlights the critical importance of meticulous wire handling and comprehensive imaging guidance in minimally invasive cardiac surgery. While the robotic system's visualization aided in repair, the primary lesson underscores the need for robust preventive strategies to avoid such complications.