Alternative approach to the repair of a floppy anterior mitral valve leaflet

Increased exertional dypsnea developed in a 25-year-old female with a long standing history of a myxomatous mitral valve. Transesophageal echocardiography demonstrated left atrial and ventricular dilatation and no significant functional impairment. In addition, there was prolapse of a voluminous anterior mitral valve leaflet as well as prolapse of the posterior leaflet. To avoid the risks of long term anticoagulation therapy including fetal teratogenicity, efforts were made to repair rather than replace this degenerated valve. Here we report a new technique of anterior or mitral valvuloplasty complementing a quadrangular resection of the mural leaflet and a ring annuloplasty. The elliptoid excision of the redundant anterior leaflet resulted in a competent valve apparatus without any significant gradient. This technique would not apply, however, when the chordae tendinae to the anterior leaflet were significantly stretched as a result of the myxomatous process. In that situation the valve would be replaced with a prosthesis.