A.L. was transferred to the operating room, placed in a supine position, and given general endotracheal anesthesia. Her pericardium was entered longitudinally through a median sternotomy. The surgeon found that her heart was enlarged with a dilated right ventricle. The left atrium was dilated. Preoperative transesophageal echocardiogram revealed severe mitral regurgitation with severe posterior and anterior prolapse. Extracorporeal circulation was established. The aorta was cross-clamped, and cardioplegic solution (to stop the heartbeat) was given into the aortic root intermittently for myocardial

protection.

The left atrium was entered via the interatrial groove on the right, exposing the mitral valve. The middle scallop of the posterior leaflet was resected. The remaining leaflets were removed to the areas of the commissures and preserved for the sliding plasty. The elongated chordae were shortened. The surgeon slid the posterior leaflet across the midline and sutured it in place. A no. 30 annuloplasty ring was sutured in place with interrupted no. 2-0 Dacron suture. The valve was tested by inflating the ventricle with NSS and proved to be competent. The left atrium was closed with continuous no. 4-0 Prolene suture. Air was removed from the heart. The cross-clamp was removed. Cardiac action resumed with normal sinus rhythm. After a period of cardiac recovery and attainment of normothermia, cardiopulmonary bypass was discontinued.

Protamine was given to counteract the heparin. Pacer wires were placed in the right atrium and ventricle. Silicone catheters were placed in the pleural and substernal spaces. The sternum and soft tissue wound was closed. A.L. recovered from her surgery and was discharged 6 days later.

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