Direct Access Implantation of a Melody Valve in Native Mitral Valve: A Hybrid Approach in the Presence of Extensive Mitral Annular Calcification

Abstract

A 76-year-old woman presented with congestive heart failure. Transthoracic echocardiogram showed severe mitral regurgitation and moderate mitral stenosis with a mean gradient of 8 mm Hg as a result of inflow obstruction in the setting of extensive mitral annular calcium with severe tricuspid regurgitation and severe pulmonary hypertension. The preoperative coronary angiogram and the computed tomography scan showed horseshoe-shaped severe mitral annular calcium (Figs 1A [arrows], 1B). Intraoperative transesophageal echocardiogram confirmed the mitral annular calcium (Fig 1D), and there was severe mitral regurgitation (Fig 1C).