Surgical technique
Following median full sternotomy, cardiopulmonary bypass was routinely
established by aortic and bicaval cannulation, and the mitral valve was
exposed via a right-sided left atriotomy under cardioplegic arrest.
Complete debridement of the infective and destructive valve tissue was
performed first (Figure 1a). Fresh autologous pericardium was harvested
and trimmed to an appropriate size corresponding to the mitral valve
defect. The size of the harvested pericardium was slightly larger than
the size of the mitral valve defect, with a 5-mm-wide seam allowance.
The mitral valve was then reconstructed with this fresh autologous
pericardium. The base of the patch was attached to the mitral annulus
with 4-0 polypropylene running sutures, and the side edges of the patch
were sutured to the remnant of the leaflet tissues with 5-0
polypropylene sutures (Figure 1b). As artificial chordae, 5-0
double-armed polytetrafluoroethylene sutures (Gore-Tex; W. L. Gore &
Associates, Newark, DE, USA) were placed to the free edge of the
reconstructed pericardium if needed (Figure 1c). Finally, mitral
annuloplasty with a prosthetic ring was performed (Figure 1d). The
prosthetic ring size was routinely determined according to the
inter-trigonal distance and anterior leaflet height.