DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Myxomatous mitral valve, Barlow valve with type II P2, with severe insufficiency.
2. Atrial septal defect.
OPERATION PERFORMED:
1. Intraoperative transesophageal echocardiogram interpretation.
2. Mitral valve repair with resection of P2 with posterior leaflet reconstruction utilizing sliding valvuloplasty and reduction annuloplasty and valve repair, 36 mm McCarthy myxomatous annuloplasty ring placement.
3. Closure of atrial septal defect, primary closure.
SURGEON: John Doe, MD
FIRST ASSISTANT: Jane Doe, PA-C
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old male with the above-mentioned problems. He had progressive mitral insufficiency with known history of floppy valve syndrome. The patient now presents, at this time, after being seen in the office. He consented to the procedure as planned with a plan to repair his valve.
DESCRIPTION OF OPERATION: The patient was brought in to the operating room and placed in the supine position. After general endotracheal anesthesia, he was prepped and draped in the usual fashion. Intraoperative transesophageal echo revealed billowing anterior and posterior leaflets. The rest of the examination was unremarkable. The aortic valve appeared to be normal. Left ventricular function was okay. The patient did have an atrial septal defect approximately 1 cm in size. It appeared to be intermittent; therefore, we suspected there was a flap over this as well. There was no evidence of any type of ventricular septal defect.
The patient was heparinized and cannulated in the usual fashion and then placed on cardiopulmonary bypass. The aorta was cross-clamped. Antegrade as well as retrograde cardioplegia arrest was obtained. The patient was also cooled systemically.
Attention was directed to the left atrium once it was opened in the conventional fashion. Retraction was placed, and valvular analysis was performed. The posterior leaflet was actually of four scallops. We cut off the middle two scallops. These were all redundant and prolapsed. This left this with quite a large deficit. We were able to take the P1 and P3 posterior leaflets off of the annulus and advance these using annular reduction sutures as well.
Once this was done, we reconstructed the posterior leaflet. It actually came together quite nicely with little to no tension present. The anterior leaflet appeared intact. At that point, we elected to use one of the newer rings, a McCarthy myxomatous valve ring, as this increased the anterior-to-posterior dimension with a decreased medial-to-lateral dimension. We used a 36 and sewed this in with horizontal mattress sutures. This seated nicely and demonstrated actually good coaptation of anterior and posterior leaflets. At that point, the left atrium was closed in two layers with 4-0 chromic suture.
At this point, the cross-clamp was removed. This patient was allowed to reperfuse while we were repairing his atrial septal defect. We did this in as primary closure with a running 4-0 chromic in two layers. At that point, the atrium was closed in a running two layer closure as well. At this point, the patient reperfused for some time and came off bypass uneventfully.
Postoperative echocardiogram revealed good functioning of the mitral valve with good coaptation of anterior and posterior leaflet. No evidence of insufficiency. The atrial septal defect at this point was now gone and totally closed. There were no abnormalities visualized.
Protamine was given to reverse heparinization. Two ventricular and one right atrial pacing wire were placed. One mediastinal and one left pleural chest tube was placed. The chest was closed in routine fashion, and the patient was transported to CVICU and postoperative room in stable condition.
