The choice of mitral valve surgical approach has always been a difficult problem in patients with small left atrium.
We report a case of a patient with Marfan syndrome who underwent the David operation and mitral valvuloplasty. The patient had a small left atrium, so we severed the superior vena cava and opened the interatrial groove and left atrial dome. This method allows for excellent exposure of the mitral valve and subvalvular apparatus, enabling a successful operation.
The interatrial groove-left atrial dome approach provides an option for patients with a small left atrium undergoing mitral valve surgery.