Repairing the mitral valve without touching the mitral valve—a novel technique

A 44-year-old gentleman presented with severe ischemic cardiomyopathy and mitral regurgitation post-inferior myocardial infarction. Echocardiography and magnetic resonance imaging revealed a dilated left ventricle with a large left ventricular aneurysm (9.3 × 9.5 cm) and associated thrombus. Severe mitral regurgitation due to leaflet tethering and a left ventricular ejection fraction (LVEF) of 25% were also seen. The patient underwent successful aneurysmectomy with patch repair and papillary muscle approximation. Following initial weaning from cardiopulmonary bypass, 6 days of postoperative temporary veno-arterial extracorporeal membrane oxygenation support were required. The patient was subsequently discharged on postoperative day sixteen with improved cardiac function (LVEF of 45%) and trace residual mitral regurgitation, highlighting the efficacy of geometric restoration in addressing such mitral regurgitation, avoiding conventional intervention on the mitral valve itself.