A case of mitral valve replacement with a collar-reinforced prosthetic valve for heavily calcified mitral annulus.

Department of Cardiovascular Surgery, NTT East Corporation Sapporo Hospital, Sapporo, Japan.
Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia (Impact Factor: 0.72). 09/2005; 11(4):260-3.
Source: PubMed


Mitral valve replacement in the presence of extensive calcification of the mitral annulus is a technical challenge. Dense calcification of the annulus can cause a great difficulty in the insertion of a prosthetic valve and later periprosthetic leakage. A radical calcium debridement may cause left circumflex coronary artery injury, atrioventricular rupture, and thromboembolic events. We report a case of a 65-year-old woman suffering from mitral regurgitation with a severely calcified mitral annulus. She underwent mitral valve replacement using a collar-reinforced prosthetic valve, which allowed the surgeon to safely insert a prosthetic valve, avoiding the calcification completely without any major complications. We recommend this method as a feasible technique for mitral valve replacement in the presence of heavily calcified or disrupted fragile mitral annulus.

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    • "This technique is simple and reproducible, and allowed the insertion of a larger prosthesis, without the need for debridement of the circumferential annular calcification. Potential complications include the transfer of the systolic intraventricular pressure to the left atrial wall, which can predispose to the risk of aneurysmal dilatation or valve dehiscence [7]. Therefore, careful follow-up with repeated echocardiograms is mandatory. "
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    ABSTRACT: Extensive annular calcification of the mitral valve can make anatomic implantation of a prosthesis extremely difficult and challenging. We herein describe a surgical technique of mitral valve replacement in a 78-year-old man with multiple medical co-morbidities suffering from severe mitral regurgitation with extensive circumferential calcification of the mitral annulus. The pertinent literature is reviewed and the technical steps and clinical presentation are discussed.
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    ABSTRACT: Extensive calcification of mitral apparatus may preclude optimal valve repair, thus requiring debridement. We performed mitral valve replacement in a 55-year-old woman with a modified bileaflet preservation technique to avoid complications related to extensive debridement. Posterior transposition of the anterior leaflet as a buttress over the posterior ventricular wall provided extra support for the weakened tissues and covered the decalcified areas, which protected against debris embolism. This technique is safe and reproducible, especially for elderly patients who have complex calcification that requires extensive debridement, enables better preservation of ventricular function, and avoids disruption of the mechanical left ventricular wall.
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    ABSTRACT: We describe the rationale, methodology, and our preliminary experience with a new surgical technique for mitral valve replacement in patients with severe calcification of the mitral annulus in which the conventional techniques can not be applied. In contrast with other procedures published in the literature for these patients, in which the placement of the prosthesis is supra-annular, we plicate both mitral leaflets and the atrial wall creating a new annulus that allows the intra-annular placement of the prosthesis.
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