The technique has been described before.11, 12, 13 In brief, a doubleorifice mitral valve is created by approximating the free edges of the leaflets at the site of regurgitation, usually with a running 4-0 polypropylene suture. In case of very thin leaflets, 1 or more U-shaped 5-0 polypropylene stitches reinforced with pledgets are used.
The operation is currently carried out through a conventional midline sternotomy during normothermic cardiopulmonary bypass with the use of intermittent cold-blood cardioplegia. The mitral valve is approached through the left atrium, with the incision done in the interatrial groove.