Totally endoscopic mitral valve repair for mitral regurgitation in double-orifice mitral valve

Double-orifice mitral valve (DOMV) is a rare congenital anomaly. Repair strategies for mitral valve prolapse in the setting of DOMV remain technically challenging. We report a case of DOMV presenting with severe mitral regurgitation (MR) due to chordal rupture and annular dilation, successfully treated with totally endoscopic mitral valve repair. Regarding the surgical approach, preserving the fibrous bridge, we repaired a DOMV via an endoscopic approach with neochords and an edge-to-edge stitch for leaflet prolapse, and a flexible band for annular dilatation, achieving trivial MR without stenosis. This case demonstrates minimally invasive mitral valve repair for DOMV, in which the regurgitation was successfully controlled while preserving the fibrous bridge and avoiding mitral stenosis.