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Updated: Jan 13, 2026

A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair

A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair

Published on: October 16, 2021

Exclusión con parche de la cavidad de calcificación anular caseificante en el surco auriculoventricular durante el

Salvatore Poddi¹, Shinya Unai¹, Gosta Pettersson¹

¹Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland OH, USA

Multimedia manual of cardiothoracic surgery : MMCTS

|January 7, 2026

Abstract:

Caseous liquefaction is a rare variant of mitral annular calcification that can lead to cavity formation in the atrioventricular groove. We report a case of mitral valve replacement in a 76-year-old woman with a large caseous cavity, coronary artery disease, severe mitral valve stenosis and atrial fibrillation. Preoperative computed tomography showed a large caseous cavity (3 x 3.5 cm) in the posterior annulus extending into the atrioventricular groove. After unroofing and evacuation, the cavity was excluded with a pericardial patch. The lower edge of the patch was sutured to the ventricular side of the cavity; valve sutures passed through the residual posterior leaflet, the upper edge of the patch and the atrial edge of the cavity. The mitral prosthesis was then secured. The patient was weaned from cardiopulmonary bypass without complications. Intraoperative echocardiography demonstrated a well-seated mitral prosthesis with no valvular or paravalvular leaks. Postoperative imaging confirmed successful exclusion of the cavity in the atrioventricular groove. The postoperative echocardiogram revealed a mean gradient of 4 mmHg across the mitral prosthesis and no mitral regurgitation. Patch exclusion of the caseous cavity is a safe and feasible approach to support implanting a mitral prosthesis and obliterating a cavity.

Palabras clave:

Calcificación Endocarditis Anillo mitral Válvula mitral Reparación de la válvula mitral Reemplazo de la válvula mitral

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