Mitral Valve Replacement while Preserving Calcified Annulus in Severe Mitral Annular Calcification

Hiroya Matabe＊	Tomoyuki Minami＊	Naoto Yabu＊
Ichiya Yamazaki＊	Shinichi Suzuki＊＊

(Department of Cardiovascular Surgery, Fujisawa City Hospital＊, Fujisawa, Japan, and Yokohama City University Hospital, the Department of Surgery, Yokohama, Japan)

A 70-years-old woman who had been on hemodialysis for 8 years was referred to our institution to undergo mitral surgery for mitral valve stenosis. Intraoperative investigations confirmed severe calcification of the posterior mitral leaflet and all-around mitral annulus. We excised the mitral leaflet using the Ultrasonic Surgical System and preserved the calcified annulus to prevent a fatal complication such as left ventricular rupture. We passed 2-0 polyester mattress sutures through the calcified annulus from the left ventricle to the left atrium, and mitral valve replacement was performed using a reversed 19 mm On-X mechanical heart valve for the aortic valve. The postoperative course was uneventful. Mitral annular calcification is a factor of fatal complications such as left ventricle rupture and coronary artery injury. We succeeded in preserving the calcified annulus and using a small diameter mechanical heart valve.

 

Jpn. J. Cardiovasc. Surg. 51: 300-303 （2022）

Keywords：mitral valve replacement; mitral annular calcification; left ventricle rupture; prosthesis-patient mismatch