Re-operative minimally invasive endoscopic mitral valve repair after partial atrioventricular canal repair.

Re-operation following previous congenital heart repair can be challenging. We present a 38-year-old female with a history of partial atrioventricular septal defect repair in infancy who developed severe mitral regurgitation due to a cleft anterior mitral leaflet. Given her anatomy and prior sternotomy, we performed a redo minimally invasive endoscopic mitral valve repair via right anterolateral minithoracotomy access. We meticulously closed the cleft using precise suture placement to restore leaflet integrity and function and performed an annuloplasty to reinforce the annulus and optimize leaflet coaptation. The minimally invasive approach minimized surgical trauma, while endoscopic visualization allowed for a precise and effective repair. This case highlights the feasibility of this approach in patients with complex congenital heart disease, offering a viable alternative to sternotomy with potential benefits for both short- and long-term outcomes.