[Mitral Valve Replacement in a Patient with Severe Mitral Annular Calcification:Report of a Case].

Mitral annular calcification (MAC) increases the risk of left ventricular rupture during mitral valve replacement (MVR). We report an 81-year-old woman with severe MAC who underwent MVR with preservation of the posterior leaflet and subvalvular apparatus, combined with selective annular debridement using an ultrasonic surgical aspirator and annular reinforcement with a bovine pericardial patch. The valve prosthesis was sewn into place with special attention to suture needle position. Our maneuver enabled safe calcification removal and implantation of an adequately sized prosthesis without left ventricular rupture or paravalvular leakage. Postoperative left ventricular function was well preserved, and the prosthetic valve showed good performance. This technique may reduce the risks of left ventricular rupture and prosthesis-patient mismatch during MVR in patients with severe MAC.