Mitral-valve replacement for a severely calcified mitral annulus: a simple and novel technique

Systemic calcifications are often seen in patients with end-stage renal failure, who need long-term hemodialysis. When patients with severe calcification of the mitral-valve annulus undergo mitral-valve replacement (MVR), complete debridement of the calcified tissues may result in fatal complications such as rupture of the left ventricle or injury to the coronary artery. We describe a novel technique of MVR for a severely calcified mitral annulus and leaflet, in which only the anterior leaflet is excised, preserving the posterior leaflet to prevent fatal complications. We passed 2/0 polyester mattress sutures through the mitral annulus from the left ventricle to the left atrium and fixed the preserved posterior leaflet to the posterior mitral annulus and prosthetic valve. The mitral valve was replaced using a St. Jude Medical mechanical heart valve with a specific structure and a hinge that shifts to the left atrial side and most of the leaflet moves within its housing. This structure enables this procedure to be performed without the excision of a severely calcified posterior mitral leaflet and annulus. Our technique may prevent the fatal complications that can be caused by debridement or excision of severely calcified mitral apparatus.