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Mitral valve replacement in the presence of severe valvular and annular calcification
1Department of Cardiovascular Surgery, Kaiser Permanente Medical Center, San Francisco, California.
Insights
Severe mitral valve calcification complicates surgical repair, often necessitating valve replacement. A novel technique allows safe insertion of a mechanical prosthetic valve, bypassing calcification and reducing complications in degenerative and rheumatic heart disease.
Area of Science:
- Cardiovascular Surgery
- Biomaterials in Medicine
- Valvular Heart Disease
Background:
- Degenerative and rheumatic mitral valve disease frequently involve extensive calcification.
- Calcification of the mitral valve annulus, leaflets, and subvalvular apparatus complicates surgical repair and valve replacement.
- Severe calcification poses technical challenges, increasing complication rates during prosthetic device implantation.
Abstract:
Degenerative and rheumatic mitral valve disease are associated with calcification of the annulus, leaflets, and subvalvular mechanism. Surgical treatment is greatly affected by the presence of such calcification, which frequently precludes successful repair, mandating valve replacement. Dense calcification of the posterior leaflet, annulus, and chordae can cause great difficulty in the insertion of a prosthetic device, and is associated with a high frequency of technical complications. We have devised a technique of replacing the mitral valve in the face of such severe calcification, which allows the surgeon to safely insert a single disc mechanical prosthetic valve, avoiding the calcification completely. A large Teflon felt collar precludes the need to place any sutures through the posterior valve leaflet. Successful early experience with five patients, exhibiting both degenerative and rheumatic disease, is described.