Article

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

ABSTRACT

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: 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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