Robotic mitral valve replacement for rheumatic mitral disease.

A 44-year-old woman presented with dyspnea on exertion. Her past medical history included rheumatic heart disease and she had been followed up for rheumatic mitral valve stenosis for the last 4 years. Her symptoms had worsened over the 3 months prior to her presentation. She was evaluated in the emergency department and electrocardiographic examination revealed atrial fibrillation. Sinus rhythm was achieved with medical treatment. A transthoracic echocardiogram revealed severe mitral valve stenosis (mitral valve area: 0.9 cm, mean mitral valve gradient: 14 mmHg), left ventricular ejection fraction of 60%, left ventricular end diastolic dimension of 4.7 cm and pulmonary artery systolic pressure of 55 mmHg. Coronary angiography demonstrated no critical stenosis. She was referred for surgical management and robotic mitral valve replacement was planned.