Simultaneous Mitral Valve Repair and Pectus Excavatum Correction

The authors present a case of mitral valve (MV) repair combined with pectus excavatum repair in a highly symptomatic 28-year-old woman. Her preoperative transesophageal (TEE) echo showed severe mitral insufficiency, and her preoperative computed tomography (CT) scan showed a Haller index of 16.3 and heart displacement to the left.

The authors’ plan was to take out all the costal cartilages starting from the second rib. Transverse sternotomy at the second intercostal space was performed. The upper part of the manubrium stayed intact. The approach to the heart was through an incision of the mediastinum along the left sternal border. The sternum was rotated in the right pleural space. A sternal retractor with 6 cm blades was inserted and cardiopulmonary bypass (CPB) was instituted using conventional cannulation techniques. The aorta was cross-clamped and cold blood cardioplegia was given. The vertical transseptal approach was used to expose the mitral valve. The MV had excessive tissues and P2 prolapse. The P2 segment was resected and sliding repair was performed. The P1-P2 and P2-P3 clefts were closed. A 38 mm semi-rigid, complete ring was inserted for MV annuloplasty. MV competence was checked. CPB was disconnected.

The sternum was rotated back in central position. The transverse sternal incision was closed with two wires. A stainless steel bar was inserted retrosternally. The bar was fixed to the edges of the left and right third ribs and to the sternum itself.

A six-month follow-up CT scan showed nice functional and aesthetic results.