Mitral regurgitation 43 years after commissurotomy by Dr. Denton A. Cooley.

To the Editor: In 2010, a 77-year-old woman presented at our hospital with shortness of breath and congestive heart failure. In 1967—43 years earlier—she had been a patient of Dr. Denton A. Cooley, who had performed commissurotomy for her mitral valve disease. The replacement valve was made of bovine pericardial tissue. In 2007, the patient had developed chronic atrial fibrillation, which was controlled with digoxin. She had no other significant comorbidities. Upon her presentation in 2010, her electrocardiogram showed atrial fibrillation, and her echocardiogram showed severe mitral regurgitation and a left ventricular ejection fraction of 0.65. The patient underwent mitral valve replacement at our hospital in March 2010. After median sternotomy and bicaval cannulation, cardiopulmonary bypass was started. The aorta was cross-clamped, myocardial protection was achieved with use of topical cooling, and cardioplegic solution was administered antegrade and retrograde. The preoperative transesophageal echocardiogram had suggested severe mitral sclerosis and insufficiency, and these were confirmed upon direct inspection. The left atrium was opened, and the mitral valve was noted to be extremely sclerotic—typical of a rheumatic-type valve. The valve was excised and was replaced with a 29-mm bovine pericardial tissue valve. A CryoMaze procedure was performed to eliminate the atrial fibrillation. The atrium was closed with use of 4-0 polypropylene suture. The patient was weaned from cardiopulmonary bypass without difficulty, and the chest was closed in standard fashion. An immediate postoperative transesophageal echocardiogram revealed no mitral insufficiency. The patient had a prolonged postoperative course because of her congestive heart failure but was discharged from the hospital in sinus rhythm and with her warfarin therapy discontinued. In 2013, an echocardiogram showed only trace amounts of mitral regurgitation. The patient subsequently developed bradycardia and sick sinus syndrome that necessitated pacemaker placement in 2014. As of May 2015, she was alive and doing well. Our patient's original mitral valve surgery was performed by Dr. Cooley during the infancy of cardiac surgery. Our patient's long life after that procedure is remarkable, and it is impressive even in the era of percutaneous balloon valvotomy.