Intra-atrial placement of a mitral prosthesis in a patient with severe mitral annulus calcification: a case report

An 88-year-old woman presented with increasing dyspnea and angina. She was found to have severe aortic stenosis, 2-vessel coronary artery disease, and severe mitral regurgitation. During surgery the patient was noted to have such severe mitral annular calcification that performing a conventional mitral valve replacement would have significantly increased the operative risk. Instead, an 8-mm Dacron graft was sutured onto the sewing cuff of a reversed 23-mm Mosaic porcine aortic valve (Medtronic, Minneapolis, MN, USA). The Dacron graft was then sutured to the left atrial wall surrounding the calcified mitral annulus. A bioprosthetic aortic valve replacement, along with a 2-vessel coronary artery bypass procedure, was also performed.