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Mitral Valve Surgery In Patients With Severe Mitral Annular Calcification - A Single Center Experience
Mohammed Mohsin Uzzaman, Lognathen Balacumaraswami, Dr.
Royal Stoke University Hospital, Stoke-On-Trent, United Kingdom.

OBJECTIVE: Longstanding Mitral valve disease with progressive regurgitation results in secondary changes which impact on whether valve is repairable. Range of pathology includes leaflet morphological changes like fibrosis and retraction or calcification which may extend into chordal apparatus. More importantly, mitral annular calcification frequently occurs in these cases and may be extensive from trigone to trigone which is termed horseshoe calcification. Mitral valve surgery in patients with severe annular calcification is challenging. We present our experience in complex mitral valve reconstruction.
METHODS: We performed complete surgical removal of calcified mitral annulus and reconstructed mitral valve apparatus in five patients. Mean age was 73+/-0 years. All patients were either NYHA 3 or 4. Two patients had poor LVF, and two patients had pulmonary hypertension. All lesions were regurgitant and mixed in one patient. Calcified annulus was resected completely en-bloc (figure) and reconstructed with equine pericardium in all patients - the LV wall around annulus was also reinforced during annular reconstruction. Valve repair successfully performed in three patients with reattachment of leaflet to reconstructed annulus with additional neochordae as required. Two cases had implantation of a suitably sized valve prostheses. There were no intra-operative complications. One case was redo procedure whilst concomitant tricuspid valve surgery was performed in two cases, Coronary bypass grafting in one case and Cox-Maze in one case
RESULTS: Median follow-up was 2 years. There was no 30-day mortality, no pacemaker implantation and no neurological sequelae. There was no significant mitral valve regurgitation at 12 months in all patients. There was significant improvement in NYHA grade (Class 0-1) and discontinuation of diuretics with resolution of heart failure.
CONCLUSIONS: In patients with severe mitral annular calcification undergoing mitral valve surgery, complete annular decalcification and reconstruction yields favourable long term outcomes.


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