Commando procedure for radiation heart disease.

The Commando procedure is an important tool to address extensive calcification of the aortic and mitral valves associated with radiation heart disease. We present a symptomatic patient with radiation heart disease associated with calcification of the mitral and aortic valves and the aortomitral curtain, which is typical of this pathology. The surgical approach consisted of exposure through aortotomy and left atrial dome, followed by aortic and mitral valve debridement, aortic and mitral valve replacement, with aortomitral curtain reconstruction using bovine pericardial patch. This procedure avoids the challenges associated with double valve repair and allows replacement with larger valves.