Off-pump transapical neo-chordae implantation.

A 61-year-old female patient presented with isolated pos ter ior mi t ra l l ea f l e t (PML) pro lapse due to degenerative mitral valve (MV). Preoperative transthoracic echocardiography confirmed severe mitral regurgitation (MR) and isolated prolapse of the P2 segment. The patient was in New York Heart Association (NYHA) functional class II to III. Her left ventricular function was good with an ejection fraction of 66%, the tricuspid annular plane systolic excursion (TAPSE) of 25 mm, a mitral annulus of 42 mm, anterior mitral leaflet (AML) length of 29 mm, PML length of 22 mm, vena contracta of 0.7 cm, and effective regurgitant orifice area (EROA) of 1.2 cm. Medical history included right lung surgery via thoracotomy for lung cancer with chemotherapy in 1982, arterial hypertension and status post hysterectomy in 2002.