title: Repeated mitral valve replacement in a patient with extensive annular calcification.
abstract: BACKGROUND
  Mitral valve replacement in the presence of severe annular calcification is a technical challenge.
  
  
  METHODS
  A 47-year-old lady who had undergone mitral and aortic valve replacement for rheumatic disease 27 years before presented with dyspnea. At reoperation, extensive mitral annular calcification was hindering the disc motion of the Starr-Edwards mitral prosthesis. The old prosthesis was removed and a St Jude Medical mechanical valve was implanted after thorough annular debridement. Postoperatively the patient developed paravalvular leak and hemolytic anemia, subsequently undergoing reoperation three days later. The mitral valve was replaced with an Edwards MIRA valve, with a bulkier sewing cuff, after more aggressive annular debridement. Although initially there was no paravalvular leak, it recurred five days later. The patient also developed a small cerebral hemorrhage. As the paravalvular leak and hemolytic anemia gradually worsened, the patient underwent reoperation 14 days later. A Carpentier-Edwards bioprosthetic valve with equine pericardial patches, one to cover the debrided calcified annulus, another as a collar around the prosthesis, was used to eliminate paravalvular leak. At 7 years postoperatively the patient is doing well without any evidence of paravalvular leak or structural valve deterioration.
  
  
  CONCLUSIONS
  Mitral valve replacement using a bioprosthesis with equine pericardial patches was useful to overcome recurrent paravalvular leak due to severe mitral annular calcification.
authors.affiliation: Department of Cardiovascular Surgery, Mitsui Memorial Hospital, 1 Kanda Izumicho, Chiyoda, Tokyo, Japan. funcorogash@hotmail.com
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kitamura
authors.forename: Sachito
authors.initials: S
authors.lastname: Fukuda
authors.forename: Takahiro
authors.initials: T
authors.lastname: Sawada
authors.forename: Sumio
authors.initials: S
authors.lastname: Miura
authors.forename: Ikutaro
authors.initials: I
authors.lastname: Kigawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Miyairi
mesh_terms: D001021:Aortic Valve / Q000601:surgery; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation; D012214:Rheumatic Heart Disease / Q000601:surgery*
references.citation: J Thorac Cardiovasc Surg. 2003 Sep;126(3):777-82
references.pmid: 14502154
references.citation: J Card Surg. 2007 Nov-Dec;22(6):502-4
references.pmid: 18039212
references.citation: J Thorac Cardiovasc Surg. 1987 Sep;94(3):399-404
references.pmid: 3626602
references.citation: ASAIO J. 1995 Jul-Sep;41(3):M763-7
references.pmid: 8573909