Port-access redo mitral valve surgery in a 13-year-old child

is reported. The patient had undergone 3 previouscardiac surgeries.At the age of 8 months, the patient underwent correctionof an anomalous left coronary artery originating from thepulmonary artery trunk with the Takeuchi procedure, and amitral valve repair with the Kay technique. At 2 years ofage, he underwent reoperation for a posterior leaflet exten-sionwithapericardialpatchasaresultofseveremitralregur-gitation. A few months later the mitral valve was replacedwith a mechanical prosthesis (17 mm; St Jude Medical, StPaul, Minn) for severe residual insufficiency. All previousprocedures were performed through a longitudinal mediansternotomy. At 13 years of age, the patient came to ourattention for onset and worsening of dyspnea (New YorkHeart Association class II-III). Upon physical examination,adiastolicprecordialmurmurwasfound.Ameangradientof12mmHgwasmeasuredbytransthoracicechocardiographywith normal movement of both prosthesis disks.Given these echocardiographic findings and symptoms,the indication for mitral prosthesis replacement wasconfirmed. Feasibility, safety, and efficacy of redo cardiacsurgeries in adults using a mini-invasive port-access plat-formhasbeenreportedpreviouslybymanyinvestigators,