Mitral Valve Replacement for a Severely Calcified Mitral Annulus

Abstract

We herein describe a surgical technique in a mitral valve replacement for a hemodialysis patient presenting with mitral valve stenosis and severe mitral annular calcification. Mitral annular calcification extending to the left ventricular myocardium was resected using a cavitron ultrasonic surgical aspirator (CUSA) to make a flat plane from the left atrium to the left ventricle. An autologous pericardium was secured to the posterior left ventricular wall and to the left atrial wall covering the mitral annulus for annular reconstruction. In the posterior mitral annulus, the prosthetic valve was fixed onto this pericardial patch. After the operation, the patient recovered well without any embolic complications. The prosthetic valve functions normally without any perivalvular leakage. Decalcification using the CUSA and the annular reconstruction with a pericardial patch is therefore indicated in valve replacement for patients with severe mitral annular calcification.

Repeated mitral valve replacement in a patient with extensive annular calcification

“…On the other hand, excessive debridement may lead to atrioventricular groove perforation or injury to the circumflex artery. When there is severe annular calcification, aggressive annular debridement together with covering the annulus with a pericardial patch may be indicated to prevent paravalvular leak [ 3 , 4 ] because the patch simply obliterates the paravalvular blood flow and because it provides better fitting between the prosthesis and the rugged annular surface. In the present case, the left ventricular pressure was elevated due to the aortic prosthetic valve gradient.…”

Mitral valve prosthesis implanted in the atrial position in a patient with extensive calcification extending from epicardium to mitral annulus

“…St Jude Epic tissue 25 mm valve (St Jude, Minneapolis, Minnesota, USA) was secured with 2–0 ethibond (Ethicon, Somerville, New Jersey, USA) sutures inserted through the CorMatrix posteriorly and the annulus anteriorly (figure 3). 2 One-year postoperative (POP) transthoracic echocardiography demonstrated normal-functioning mitral prosthesis and no paravalvular leak (see online supplementary video 2). Differential diagnoses include extensive calcifications secondary to renal failure, malignancy, autoimmune disorder, viral syndromes, radiation therapy, rheumatic heart and congenital heart disease; in the absence of such history, they were possibly idiopathic or degenerative in nature.…”

“…Multimodality testing including CT scan,2 transoesophageal echocardiography and cardiac catheterisation can help in preplanning for surgery.…”

Echocardiographic Assessment of Degenerative Mitral Stenosis: A Diagnostic Challenge of an Emerging Cardiac Disease

“…[5][6][7] Some innovative surgical techniques such as supra-annular insertion of a prosthesis or the use of a felt patch around the orifice as an anchor for prosthesis have been reported. 8,9 More recently, transcatheter MV replacement (TMVR) with "off-label" use of transchateter aortic valve replacement (TAVR) devices in DMS have been described (Figure 1). …”