• Journal of Chest Surgery
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• v.57 no.5
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• pp.496-499
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• 2024

Calcification of the mitral valve annulus is common in patients on dialysis. The growing number of individuals receiving dialysis has been accompanied by an increase in cases necessitating surgical intervention for mitral valve annulus calcification. In this report, we present a severe case characterized by bulky calcification of the mitral annulus, which was managed with mechanical mitral valve replacement. A 61-year-old man on dialysis presented with chest pain upon exertion that had persisted for 3 months. Cardiac echocardiography revealed severe mitral stenosis and regurgitation, accompanied by cardiac dysfunction. During surgery, an ultrasonic aspiration system was employed to remove the calcification of the mitral valve annulus to the necessary extent. Subsequently, a mechanical mitral valve was sutured into the supra-annular position. To address the regurgitation, the area surrounding the valve was sewn to the wall of the left atrium. Postoperative assessments indicated an absence of perivalvular leak and demonstrated improved cardiac function. The patient was discharged on postoperative day 22. We describe a successful mitral mechanical valve replacement in a case of extensive circumferential mitral annular calcification. Even with severe calcification extending into the left ventricular myocardium, we were able to minimize the decalcification process. This approach enabled the performance of mitral mechanical valve replacement in a high-risk patient on dialysis, thus expanding the possibilities for cardiac surgery.

• Journal of Chest Surgery
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• v.48 no.5
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• pp.328-334
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• 2015

Background: There have been a number of studies on mitral valve replacement and repeated percutaneous mitral balloon valvotomy for mitral valve restenosis after percutaneous mitral balloon valvotomy. However, studies on mitral valve repair for these patients are rare. In this study, we analyzed postoperative outcomes of mitral valve repair for mitral valve restenosis after percutaneous mitral balloon valvotomy. Methods: In this study, we assessed 15 patients (mean age, $47.7{\pm}9.7years$; 11 female and 4 male) who underwent mitral valve repair between August 2008 and March 2013 for symptomatic mitral valve restenosis after percutaneous mitral balloon valvotomy. The mean interval between the initial percutaneous mitral balloon valvotomy and the mitral valve repair was $13.5{\pm}7years$. The mean preoperative Wilkins score was $9.4{\pm}2.6$. Results: The mean mitral valve area obtained using planimetry increased from $1.16{\pm}0.16cm^2$ to $1.62{\pm}0.34cm^2$ (p=0.0001). The mean pressure half time obtained using Doppler ultrasound decreased from $202.4{\pm}58.6ms$ to $152{\pm}50.2ms$ (p=0.0001). The mean pressure gradient obtained using Doppler ultrasound decreased from $9.4{\pm}4.0mmHg$ to $5.8{\pm}1.5mmHg$ (p=0.0021). There were no early or late deaths. Thromboembolic events or infective endocarditis did not occur. Reoperations such as mitral valve repair or mitral valve replacement were not performed during the follow-up period ($39{\pm}16months$). The 5-year event-free survival was 56.16% (95% confidence interval, 47.467-64.866). Conclusion: On the basis of these results, we could not conclude that mitral valve repair could be an alternative for patients with mitral valve restenosis after percutaneous balloon mitral valvotomy. However, some patients presented with results similar to those of mitral valve replacement. Further studies including more patients with long-term follow-up are necessary to determine the possibility of this application of mitral valve repair.

• Journal of Chest Surgery
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• v.37 no.8
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• pp.722-725
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• 2004

Mitral valve surgery is most commonly performed through the left atriotomy via the inter-atrial groove or trans-septal approach. An alternative method for approaching to the mitral valve is via the dome of the left atrium located between the ascending aorta and superior vena cava. Although this approach was described 30 years ago, it has not been popularized in mitral valve surgery. We introduce our recent experiences with mitral valve surgery carried out through the dome of the left atrium with brief review of literature.

• Journal of Chest Surgery
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• v.55 no.2
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• pp.177-179
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• 2022

Barlow's disease with mitral annular calcification encompassing the subvalvular apparatus, including the valve leaflet and chordae, is extremely rare, and mitral valve repair in such cases is challenging. We report a case of a 60-year-old woman with mitral valve regurgitation that was successfully controlled by resecting the rough zone of P2 and calcifications on the excess leaflet regions and subvalvular apparatus, while retaining the calcification of P3 and implanting artificial chordae and an annuloplasty ring. Mitral valve repair for such cases requires an individualized and compounded surgical strategy for the technique to treat Barlow's disease and manage calcification to control mitral regurgitation.

• Journal of Chest Surgery
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• v.11 no.4
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• pp.428-432
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• 1978

Between Jan. and Oct. 1978, mitral valve Replacement had been performed on eight patients using porcine aortic valve mounted on flexible polypropylene or Egyloil wire and Dacron covered stent. Mitral valve replacement was performed on five, mitral valve replacement with tricuspid valve replacement on two, and mitral valve replacement with tricuspid valve annuloplasty on 1 patient using five Carpentier and five Hancock Xenograft. Overall operative deaths were 2 cases. All other 6 cases did well after surgery and improved. No systemic thromboembolism occurred without anticoagulant-No valve failure took place. The results are satisfactory.

• Journal of Chest Surgery
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• v.50 no.6
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• pp.467-470
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• 2017

Extensive mitral annulus calcifications are considered a contraindication for valve surgery. We describe the case of a 76-year-old female with severe mitral and aortic stenosis associated with extensive calcifications of the heart. The patient underwent an open mitroaortic valve replacement using transcatheter aortic valve implantation with an Edwards SAPIEN XT valve (Edwards Lifesciences Corp., Irvine, CA, USA) in the mitral position. The aortic valve was replaced using a stentless valve prosthesis (LivaNova S OLO; LivaNova PLC, London, UK). Postoperative echocardiography showed that the prosthetic valve was in the correct position and there were no paravalvular leaks. A bailout open transcatheter valve implantation can be considered a safe and effective option in selected cases with an extensively calcified mitral valve.

• Journal of Chest Surgery
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• v.49 no.1
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• pp.46-49
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• 2016

The concomitant presence of posterior mitral annular calcification and infectious mitral valve lesions poses a technical challenge with considerable perioperative risk when using previously proposed techniques for mitral valve surgery. Herein, we report a case of the use of a modified surgical technique to successfully treat a patient with mitral infective endocarditis complicated by a subendocardial abscess and extensive posterior mitral annular calcification.

• Journal of Chest Surgery
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• v.27 no.4
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• pp.313-317
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• 1994

Surgical treatment is possible for the obstructive form of hypertrophic cardiomyopathy and transaortic left ventricular septal myectomy and myotomy has been the procedure of choice. If coexisting intrinsic mitral valve disease exists, mitral valve replacement has been performed. But abnormal systolic anterior motion of anterior mitral leaflet[SAM] with intrinsic normal mitral valve disease is the typical feature of IHSS and we prefer not to replace mitral valve. 3 patients underwent transaortic myotomy and myectomy for IHSS with mitral regurgitation. 2 patients of them have coexisting intrinsic mitral valve diseases such as mitral valve vegetation and chorda rupture. Concomittent mitral valve replacement were performed. 1 patient shows SAM of mitral anterior leaflet but has intrinsic normal mitral valve morphologically and transepicardial echocardiogram and direct monitoring of pressure gradient during the operative procedure gives better information for subsided mitral regurgitation. Post operative course during the 12 months follow-up was uneventful.

• Journal of Chest Surgery
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• v.13 no.2
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• pp.92-99
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• 1980

From 1958 up to the end of April 1980, during the period of 12 years 1640 cardiac surgery cases including 1069 open heart surgery and 304 valve replacement cases, were operated in this Department. There were 1070 congenital anomaly and 570 acquired disease cases. In 1070 congenital anomaly cases 673 acyanotic and 397 cyanotic anomaly patients were noted. In acquired diseases 94 pericardial and 456 valvular cases were found. Among 456 valve cases 189 mitral stenosis, 133 mitral insufficiency, 30 aortic valve lesion, 97 double valve, and 7 triple valve lesion patients were noted. Among 304 valve replacement cases 209 mitral, 34 aortic, 5 tricuspid, 34 aortic with mitral, 20 mitral with tricuspid, and 2 triple valves were replaced. Annual increase `of open heart surgery cases and decrease of operative deaths were remarkable in recent years. In recent years Shiley** oxygenator in pump-oxygenator set up and Ionescu** bovine pericardial xenograft bioprosthesis were used for valve replacement mainly.

• Journal of Chest Surgery
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• v.51 no.2
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• pp.149-152
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• 2018

A 76-day-old infant weighing 3.4 kg was referred for surgical intervention for severe mitral valve stenoinsufficiency caused by leaflet fibrosis and calcification. He had ex perienced a cerebral infarction in the left middle cerebral artery territory, which was deemed attributable to an embolism of a calcified particle from the dysmorphic mitral valve. Because mitral valve replacement using a prosthetic valve was not feasible in this small baby, mitral valve replacement with a pulmonary autograft was performed. After a brief period of extracorporeal membrane oxygenation (ECMO) support, he was weaned from ECMO and was discharged home without further cardiovascular complications.