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Picture shows multiple ruptured chordae in a patient who had endocarditis and was treated for 6 weeks. All chordae to A2 and A3 segment of the mitral valve where ruptured. They were excised , Artificial chordae with Goretex CV4 sutures were made using a loop over loop technique described by Tirone David using one Goretex suture to make ultimately 10 neochordae to suspend the whole of A2 and A3. An annuloplasty was done with a Goretex steel ring and a pseudocleft in the posterior leaflet was closed. Patient has trivial MR on post op echo and incidentally had long QT syndrome which subsided with cessation of preoperative cardorone.LQTS was suspected because the patient fibrillated while opening the pericardium and was defibrillated and while taking purse strings again had resistant fibrillation which necessitated going on CPB and did not defibrillate even after cardiac unloading. Heart was pleged and procedure was done. Patient came of in a slow sinus rhythm with ventricular ectopics which was surpressed with atrial pacing. On shifitng QT was analyzed formally on a 12 lead ECG which showed it was 680 msec and decreased to 330 msec over 5 days after cessation of Carddarone and magnesium supplementation.
