DOI: https://doi.org/10.36347/sjmcr.2026.v14i06.033

Pages: 1458-1461

Left ventricular (LV) aneurysm formation after myocardial infarction frequently leads to secondary functional mitral regurgitation (MR) through geometric distortion of the left ventricle. Although severe functional MR generally warrants surgical correction, the management of moderate functional MR during LV reconstruction remains controversial. We present the case of a 74-year-old male scheduled for coronary artery bypass grafting (CABG), LV aneurysmectomy, and mitral valvuloplasty for a large inferior LV aneurysm and moderate functional MR. Intraoperative transesophageal echocardiography (TEE) performed immediately after LV aneurysmectomy demonstrated a marked qualitative reduction in MR severity. Recognizing that restoring LV geometry effectively corrected the functional subvalvular tethering mechanism, the surgical team avoided the planned mitral valvuloplasty and right coronary artery bypass grafting. The patient was successfully weaned from cardiopulmonary bypass (CPB) without complications, and follow-up transthoracic echocardiography (TTE) at 5 months demonstrated only mild residual MR. This case highlights the pivotal role of real-time intraoperative TEE in guiding dynamic surgical decisions and preventing redundant valvular interventions by directly assessing immediate geometric restoration.