Mitral valve repair without mitral annuloplasty with extensive mitral annular calcification

In mitral valve repair, removal of mitral annular calcification (MAC) is necessary to secure the artificial ring but may cause rupture of the left ventricle or injury to the circumflex coronary artery. We experienced 3 cases of mitral valve regurgitation with extensive MAC. Patient 1, an 83-year old woman, had P1-P2 prolapse due to tendon rupture. We performed mitral valve repair with triangular resection of P2 and patch reconstruction, artificial-chordal reconstruction to P2 and anterolateral commissural edge-to-edge suturing. Patient 2 was a 76-year old man with P3 prolapse due to tendon rupture. We performed A3-P3 edge-to-edge suturing and small annular plication of the posteromedial commissure. Patient 3, an 84-year old woman with a non-specific coaptation defect in the anterolateral commissure and tenting of the anterior mitral leaflet due to a secondary chorda, underwent cutting of the secondary chorda of the anterior mitral leaflet and A1-P1 edge-to-edge suturing. We performed tricuspid annuloplasty in Patient 1 and aortic valve replacement in Patients 2 and 3. Postoperative echocardiography showed good control of mitral valve regurgitation, which we were able to regulate by repairing the leaflets and chordae without decalcification of the mitral annulus or implantation of an artificial ring.