Coming undone: a case of annuloplasty ring suture degeneration post mitral valve repair leading to recurrent severe MR

SUMMARY: Mitral valve repair is the gold standard treatment for degenerative mitral valve disease with superior perioperative and long-term morbidity and mortality outcomes vs mitral valve replacement. The 10 year survival freedom from redo valve repair varies from 72 to 90%. Often, failure of valve repair necessitating redo surgery is directly related to disease progression; however, rarely it can be attributed to technical complications such as annuloplasty dehiscence, leaflet suture rupture, incorrect artificial chord length or incorrect annuloplasty position. We report one such case of severe mitral regurgitation secondary to a degenerative annuloplasty ring suture occurring 1 year post valve repair. LEARNING POINTS: Differentiation of causative pathology involved in recurrent mitral regurgitation following repair has important implications for patient outcomes. In the hands of an experienced practitioner echocardiography – in particular, integrated 2D- and 3D echocardiography – is a powerful tool for differentiating between progressive disease and procedural failure.