Mitral valve repair with decalcification of the annulus and pericardial patch repair via the trans-septal approach.

Median sternotomy was performed and cardiopulmonary bypass was established using bi-caval cannulation. Cardiac standstill was obtained with antegrade cardioplegia after cross-clamping the aorta. The caval tapes were snared and the right atrium (RA) was opened. An incision was made in the fossa ovalis and was extended into the left atrium (LA). Stay sutures were placed on the edge of the incision for exposure. Annulus sutures with 2-0 Ethibond were placed for better exposure.