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A simple solution to a difficult problem: mitral pannus removal using a minimal access approach

(figure 1F, see online supplementary video 4), and sent for histology that revealed fibrous connective tissue covered by fibrin. After complete resection of the mass, the mechanical valve was noted not to have any dysfunction and was hence not replaced. The patient had an uneventful postoperative recovery and was discharged home on day 4 post-surgery. David Rose, Palanikumar Saravanan, Joseph Zacharias Lancashire Cardiac Centre, Blackpool, Lancashire, UK

A 64-year-old woman had a mitral valve repair 10 years previously and subsequently had her mitral valve replaced for recurrence of severe mitral regurgitation with a 29-mm St Jude’s bileaflet mechanical prosthesis at another institution 5 years ago. She presented to our department following a recent transient ischaemic attack and an echogenic lesion was picked up on the sewing ring of her mitral prosthesis (figure 1A, see online supplementary video 1). A transoesophageal echocardiography confirmed the presence of a mobile filiform extension, measuring 1×2 cm, on the anterior aspect of the mitral valve, that partially prolapsed into the left ventricle during diastole but without affecting the mitral prosthesis function (figure 1B, C, see online supplementary video 2). The patient was scheduled for a Thru-PORT approach to mitral valve exploration. This approach involves cannulation of the femoral vessels for establishing cardiopulmonary bypass. A balloon endoclamp is used to isolate the heart and deliver cardioplegia. A 4-inch right minithoracotomy is then made to access the left atrium. A 5.5-mm camera is used to improve illumination, magnification and visualisation.1 The procedure is done under video assistance and the mass was identified presenting a stalk localised on the anterior tilting disc (figure 1D, E, see online supplementary video 3). The pannus was then resected

Correspondence to Dr David Rose, Lancashire Cardiac Centre, Whinney Heys Road, Blackpool, Lancashire FY3 8NR, UK; [email protected] Contributors JZ and PS: conception of the draft and final approval of the version to be published. DR: design and drafting the article. Competing interests None. Patient consent Obtained. Provenance and peer review Not commissioned; externally peer reviewed. ▸ Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/heartjnl-2013-304139). To cite Rose D, Saravanan P, Zacharias J. Heart 2014;100:182. Received 8 May 2013 Revised 22 May 2013 Accepted 18 June 2013 Published Online First 7 August 2013 Heart 2014;100:182. doi:10.1136/heartjnl-2013-304139

REFERENCE 1

Vanermen H, Wellens F, De Geest R, et al. Video-assisted Port-Access mitral valve surgery: from debut to routine surgery. Will Trocar-Port-Access cardiac surgery ultimately lead to robotic cardiac surgery? Semin Thorac Cardiovasc Surg 1999;11:223–34.

Figure 1 (A) Transoesophageal echocardiography. White arrow shows the pannus localised on the anterior aspect of the mitral valve. (B) Three-dimensional (3D) transoesophageal echocardiography reconstruction showing the pannus (black arrow) on the closed mechanical mitral valve. (C) 3D transoesophageal echocardiography reconstruction showing the pannus (black arrow) inside the opened mechanical mitral valve. (D) Intraoperative picture showing the pannus on the anterior tilting disc (black arrow). (E) Intraoperative picture showing the removal of the pannus. (F) Post-removal intraoperative picture showing an intact mechanical valve.

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Rose D, et al. Heart January 2014 Vol 100 No 2

Downloaded from heart.bmj.com on September 25, 2014 - Published by group.bmj.com

A simple solution to a difficult problem: mitral pannus removal using a minimal access approach David Rose, Palanikumar Saravanan and Joseph Zacharias Heart 2014 100: 182 originally published online August 7, 2013

doi: 10.1136/heartjnl-2013-304139

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