Standardized Surgical Management Strategy for Rheumatic Mitral Valve Disease

Building on years of surgical experience, the authors developed a standardized mitral valve repair technique that has been refined and disseminated nationwide. Additionally, they established preoperative predictive models based on echocardiography and cardiac computed tomography (CT) that demonstrate superior predictive performance compared with the Wilkins Score. 

This video presents a 73-year-old female with exertional dyspnea for over one month. Preoperative evaluation revealed rheumatic mitral valve disease with moderate-to-severe mitral stenosis (mitral valve area 1.3 cm²), moderate mitral regurgitation, and moderate tricuspid regurgitation. According to current guidelines, surgical intervention was indicated; however, the choice between repair and replacement remained uncertain. The Society of Thoracic Surgeons (STS) Score was 1.28. A multimodality assessment estimated a repair probability of more than 80 percent, supporting repair as the first-line strategy.  

The patient underwent mitral valve repair, tricuspid valve repair, and a Maze procedure via median sternotomy. The mitral valve repair procedure (Improved SCORE-A6) consists of six key steps: aggressive shaving, checking, commissurotomy, dividing, relaxing, and peeling.  

Postoperative transesophageal echocardiography confirmed an excellent repair result. At discharge, the follow-up examinations demonstrated stable findings, including a mitral valve area of 3.0 cm², trivial residual regurgitation, and restoration of sinus rhythm. 

By integrating predictive models into preoperative evaluation and applying standardized intraoperative repair techniques, the authors established a surgical management strategy that renders rheumatic mitral valve repair more standardized, reproducible, and generalizable. This approach can improve surgical outcomes, reduce the disease burden in high-prevalence regions, and enhance the long-term prognosis for patients with rheumatic mitral valve disease. 

References

1. Liu Z, Zhang H, Wang M, Ren Y, Liang J, Zhao S, Liu R, Han J, Ye H, Zhang H, Xu L, Jiang W. Predictors and prognosis of mild regurgitation after rheumatic mitral valve repair: A dual-center cohort analysis on the basis of cardiac computed tomography. J Thorac Cardiovasc Surg. 2025 Aug 5:S0022-5223(25)00651-8.
2. Wang M, Zhang H, Liu Z, Han J, Liu J, Zhang N, Li S, Tang W, Liu P, Tian B, Luo T, Wang J, Meng X, Ye H, Xu L, Zhang H, Jiang W. Scoring model based on cardiac CT and clinical factors to predict early good mitral valve repair in rheumatic mitral disease. Eur Radiol. 2024 Aug;34(8):4963-4976.
3. S Jia, T Liu, X Hao, J Han, Y He, W Jiang, H Zhang, Establishment and validation of a prediction model for the outcome of rheumatic mitral valve repair surgery based on transthoracic echocardiography, European Heart Journal, Volume 45, Issue Supplement_1, October 2024, ehae666.118
4. Praz F, Borger MA, Lanz J, Marin-Cuartas M, Abreu A, Adamo M, Ajmone Marsan N, Barili F, Bonaros N, Cosyns B, De Paulis R, Gamra H, Jahangiri M, Jeppsson A, Klautz RJM, Mores B, Pérez-David E, Pöss J, Prendergast BD, Rocca B, Rossello X, Suzuki M, Thiele H, Tribouilloy CM, Wojakowski W; ESC/EACTS Scientific Document Group. 2025 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2025 Nov 21;46(44):4635-4736.

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