Trapped Mitral Leaflet

Abstract

Although mitral valve replacement may be considered a core competency for any cardiac surgeon, it is far from a trivial procedure. Complications range from paravalvular leak to leaflet immobility to atrioventricular groove disruption. In this case you have been called upon to perform a mitral valve replacement in a young patient with rheumatic heart disease. Given her young age you elect to implant a mechanical prosthesis after discussion with the patient, preserving the posterior leaflet and chordal attachments but sacrificing the anterior leaflet. Much to your chagrin, after weaning from bypass the anesthesiologist performing the transesophageal echo reports that one of the leaflets is immobile. You resume bypass and explore the prosthesis. Finding no obvious cause, you resort to rotating it 45 degrees hoping for the best. Recognizing that hope is not a robust strategy, you are relieved when upon weaning from bypass both leaflets are moving normally. The approach to the trapped mitral leaflet identified intraoperatively is discussed.