Minimally Invasive Mitral Valve Repair in a Patient With Severe Scoliosis: Overcoming Anatomical Challenges

Spinal deformities such as scoliosis present significant challenges in cardiac surgery due to thoracic anatomical distortion, restrictive lung physiology, and elevated perioperative risk. Minimally invasive mitral valve surgery offers reduced surgical trauma, shorter recovery, and lower complication rates compared to sternotomy, and may provide advantages in anatomically complex patients. However, such cases demand advanced technical precision, as distorted anatomy complicates cannulation, visualization, and valve exposure. We present the case of a 48-year-old patient with very severe thoracolumbar scoliosis (Cobb angle 130°) who underwent minimally invasive mitral valve repair via a 5-cm right mini-thoracotomy. Despite substantial anatomical challenges, the procedure was completed successfully using tailored cannulation strategies, heart repositioning techniques, and meticulous preoperative planning. The patient recovered without complications, was discharged on day four, and follow-up echocardiography confirmed normal valve function with marked symptomatic improvement. This case highlights the feasibility of minimally invasive mitral valve repair in anatomically extreme patients when performed with individualized planning, intraoperative adaptability, and institutional expertise.