Three-dimensional, totally endoscopic mitral valve repair of anomalous mitral arcade.

We report the case of a 15-year-old boy with severe mitral valve insufficiency due to an anomalous mitral arcade. Both papillary muscles were elongated and attached directly to the anterior leaflet, creating an arcade shape. He underwent an operation using a right minithoracotomy approach under three-dimensional endoscopic vision. Both papillary muscles were dissected off the anterior leaflet and trimmed. A muscle bar existed from the left ventricular wall to the right-side tip of the posterior papillary muscle and was also dissected off. Four loops were reconstructed from the papillary muscles and fixed to the free margin of the anterior leaflet in appropriate positions. After a 28-mm semi-rigid band was inserted, the posterior commissure was closed, and edge-to-edge stitches were applied from the posterior commissure to the P3 and the A3 segments to achieve better competence. His mitral valve was successfully repaired. The transoesophageal echocardiogram showed good opening of the mitral valve and trace regurgitation. The endoscope was useful for detailed observation and evaluation of the structure and abnormalities of the mitral valve and subvalvular apparatus.