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J Chest Surg

Published online June 5, 2024

Copyright © Journal of Chest Surgery.

Mitral Valve Replacement for Bulky, Calcified Mitral Annulus: A Case Report

Yusuke Nakata , M.D., Kazuyuki Miyamoto , Ph.D.

Department of Cardiovascular Surgery, Fukuoka Red Cross Hospital, Fukuoka, Japan

Correspondence to:Yusuke Nakata
Tel 81-0892-521-1211
Fax 81-0892-522-3066
E-mail y-nakata@fukuoka-med.jrc.or.jp
ORCID
https://orcid.org/0000-0002-6541-2132

Received: February 19, 2024; Revised: March 22, 2024; Accepted: April 10, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Calcification of the mitral valve annulus is common in patients on dialysis. The growing number of individuals receiving dialysis has been accompanied by an increase in cases necessitating surgical intervention for mitral valve annulus calcification. In this report, we present a severe case characterized by bulky calcification of the mitral annulus, which was managed with mechanical mitral valve replacement. A 61-year-old man on dialysis presented with chest pain upon exertion that had persisted for 3 months. Cardiac echocardiography revealed severe mitral stenosis and regurgitation, accompanied by cardiac dysfunction. During surgery, an ultrasonic aspiration system was employed to remove the calcification of the mitral valve annulus to the necessary extent. Subsequently, a mechanical mitral valve was sutured into the supra-annular position. To address the regurgitation, the area surrounding the valve was sewn to the wall of the left atrium. Postoperative assessments indicated an absence of perivalvular leak and demonstrated improved cardiac function. The patient was discharged on postoperative day 22. We describe a successful mitral mechanical valve replacement in a case of extensive circumferential mitral annular calcification. Even with severe calcification extending into the left ventricular myocardium, we were able to minimize the decalcification process. This approach enabled the performance of mitral mechanical valve replacement in a high-risk patient on dialysis, thus expanding the possibilities for cardiac surgery.

Keywords: Mitral annular calcification, Mitral valve replacement, Mechanical valve, Mitral valve stenosis, Mitral valve insufficiency, Case reports

Article

ahead

J Chest Surg

Published online June 5, 2024

Copyright © Journal of Chest Surgery.

Mitral Valve Replacement for Bulky, Calcified Mitral Annulus: A Case Report

Yusuke Nakata , M.D., Kazuyuki Miyamoto , Ph.D.

Department of Cardiovascular Surgery, Fukuoka Red Cross Hospital, Fukuoka, Japan

Correspondence to:Yusuke Nakata
Tel 81-0892-521-1211
Fax 81-0892-522-3066
E-mail y-nakata@fukuoka-med.jrc.or.jp
ORCID
https://orcid.org/0000-0002-6541-2132

Received: February 19, 2024; Revised: March 22, 2024; Accepted: April 10, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Calcification of the mitral valve annulus is common in patients on dialysis. The growing number of individuals receiving dialysis has been accompanied by an increase in cases necessitating surgical intervention for mitral valve annulus calcification. In this report, we present a severe case characterized by bulky calcification of the mitral annulus, which was managed with mechanical mitral valve replacement. A 61-year-old man on dialysis presented with chest pain upon exertion that had persisted for 3 months. Cardiac echocardiography revealed severe mitral stenosis and regurgitation, accompanied by cardiac dysfunction. During surgery, an ultrasonic aspiration system was employed to remove the calcification of the mitral valve annulus to the necessary extent. Subsequently, a mechanical mitral valve was sutured into the supra-annular position. To address the regurgitation, the area surrounding the valve was sewn to the wall of the left atrium. Postoperative assessments indicated an absence of perivalvular leak and demonstrated improved cardiac function. The patient was discharged on postoperative day 22. We describe a successful mitral mechanical valve replacement in a case of extensive circumferential mitral annular calcification. Even with severe calcification extending into the left ventricular myocardium, we were able to minimize the decalcification process. This approach enabled the performance of mitral mechanical valve replacement in a high-risk patient on dialysis, thus expanding the possibilities for cardiac surgery.

Keywords: Mitral annular calcification, Mitral valve replacement, Mechanical valve, Mitral valve stenosis, Mitral valve insufficiency, Case reports

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