Chordal Sparing Operation: For sparing both leaflets, an incision is made on the anterior leaflet close to the annulus and then extended centrally and the two segments, are folded towards the posterior leaflet and pledgetted mattress sutures taken. Decision is taken whether a prosthetic or bioprosthetic valve is to be inserted. Then the correct sized valve is chosen. In a stenotic valve with a small LV, a low profile valve is the best choice-St. Jude 01- Medtronic Hall. When the left
ventricle is large, a Starr-Edward valve can be inserted. Deairing should be thoroughly done. It is not advisable to lift the LV for deairing through the apex when a bioprosthetic valve has been inserted. Some patients with AF will require suturing of atrial appendage from inside and a COX LU (MAZE) procedure as described in the case of open mitral valvotomy.