Modification of the intra-atrial mitral valve prosthesis implantation in cases of heavy mitral annulus calcification

Abstract

We read with interest the case report titled ‘Intra-atrial implantation of a mitral valve prosthesis in a heavily calcified mitral annulus’ by Atoui et al. [1]. As noted in the article, in cases of severe mitral valve annulus calcification there is always difficulty implanting the prosthetic valve. We agree that the presented technique can be life saving; however, it should be remembered that there remains the risk of dehiscence due to the weakness of the left atrial wall and paravalvular leak is an important and common complication. In a similar patient who had presented to our centre with severe congenital mitral regurgitation in childhood, due to impossibility of implanting the prosthetic valve in the annulus, the valvewas placed in the left atrialwall. Thepatient presented2 years laterwith severe paravalvular leak and the next surgeon considering this as only a paravalvular leak proceeded with closing the leak. Unfortunately, the patient developed paravalvular leak and dehiscence again as a result of the left atrial wall weakness. In such cases, we recommend using a two-layered Dacron patch to reduce tension to the left atrial wall. A hole is made in the centre of the patch where the valve is to be placed and sutured. Then the Dacron with the prosthetic valve implanted in its centre is sutured to the left atrial wall. With this technique the chance of dehiscence from the left atrial wall is reduced.