Minimally Invasive Approach for Mitral Valve Repair in a Patient With Prior Pentalogy of Fallot Repair

Abstract

A 54-year-old woman with a history of pentalogy of Fallot with a right-sided aortic arch underwent a classic left Blalock shunt as a newborn and ventricular septal defect closure, resection of subvalvular right ventricular outflow tract obstruction, and pulmonary valvulotomy at 2 years of age. She subsequently had a transcatheter device closure of her atrial septal defect 8 years ago. She now presents with symptomatic severe mitral insufficiency caused by a flail posterior leaflet. Consistent with the patient’s diagnosis of pentalogy of Fallot, this patient has dextroposition and anterior displacement of the aorta, thus making sternal reentry perilous and compounding her operative risk for reoperative mitral valve surgery. 1 The dextroposition of the aorta and presence of an atrial septal device were also likely to limit exposure of the mitral valve through a sternotomy and preclude the use of a transseptal approach.