Abstract
BackgroundMitral valve replacement in the presence of severe annular calcification is a technical challenge.Case reportA 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.ConclusionMitral valve replacement using a bioprosthesis with equine pericardial patches was useful to overcome recurrent paravalvular leak due to severe mitral annular calcification.
Highlights
Severe annular calcification of the mitral valve is a major challenge to cardiac surgeons
Mitral valve replacement using a bioprosthesis with equine pericardial patches was useful to overcome recurrent paravalvular leak due to severe mitral annular calcification
We present a case of prosthetic valve disorder of the mitral valve with extended annular calcification which developed 27 years after the initial surgery, requiring redo valve replacement three times to manage a paravalvular leak
Summary
Severe annular calcification of the mitral valve is a major challenge to cardiac surgeons. We present a case of prosthetic valve disorder of the mitral valve with extended annular calcification which developed 27 years after the initial surgery, requiring redo valve replacement three times to manage a paravalvular leak. It was decided to redo the operation and a prosthesis with a heavier sewing cuff (MIRA; Edwards Lifesciences) was used this time. This reoperation was performed three days after the previous operation. A crack was found in the posterior part of the mitral annulus, and, after more aggressive debridement, a 25 mm MIRA valve was implanted in a paraannular position. Five days after the second operation, TEE revealed recurrent paravalvular leak which gradually worsened, and again hemolysis developed. At 7 years postoperatively, she has been doing well in NYHA functional class I without any evidence of paravalvular leak or structural valve deterioration
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
