Advanced techniques in mitral annular calcification management.

BACKGROUND

The management of severe mitral annular calcification (MAC) with a conservative approach minimizes the risk of atrioventricular groove (AVG) disrupture. However, patients with a history of rheumatic valve disease may present with complex and mixed annular lesions requiring extensive debridement. Our technique for reconstructing the mitral annular plane after mechanical decalcification is presented.

METHODS

This is a video of the surgical management of two cases of mitral valve rheumatic disease (one of which with superimposed native-valve-endocarditis) with severe MAC. After extensive mitral annulus debridement, the naked area of myocardium in the AVG is covered and reinforced using a patching technique. It is important to sew the patch of autologous pericardium with a double suture line: one line down in the ventricle, the other one inside the atrium. The valvular stitches have to be passed proximal to the patch, thus de facto atrializing the position of the prosthetic mitral valve.

RESULTS

An optimal result was achieved in both cases. The double suture line avoids the risk of blood infiltrating behind the valve, into the AV groove, causing cardiac rupture.

CONCLUSIONS

Reconstructing the posterior mitral valve annulus with a patch of autologous pericardium and related atrialization of the prosthetic mitral valve is a safe and feasible technique to manage severe MAC.