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This case had significant mitral stenosis and Grade II MR an LA clot and a history of CVA.. The patient underwent a mitral valve repair which required significant mitral commissurotomy, posterobasal chordal release, pseudocleft closure that resulted in perfect competence on both apical saline insufflation and epicardial echocardiography. The patient had clot removal and and an emaze done.
I have photographed the main steps viz
Valve analysis
Traction sutures on leaflets and crossing them to enhance the definition of the commissures.
Marking the end of the commissure and the mitral veil with a stab with a 11 No Blade.
Hooking of the subvalvar with a Mixter and division of the fused commissure with a 15 No blade and proceeding to divided inferiorly into the subvalvar while cautiously "sharing" subvalvar structures bilaterally to both AML and PML.
The process is repeated on the opposite side.
In this case post commissurotomy the residual leak was judged to be from a pseudocleft between P2 and P3 which was closed (Usually is not required with pure MS).
