Mitral valve prosthesis implanted in the atrial position in a patient with extensive calcification extending from epicardium to mitral annulus

Description

A 72-year-old woman with progressive dyspnoea underwent transoesophageal echocardiography demonstrating mixed mitral stenosis and regurgitation, extensive mitral annular calcification (MAC), left atrial appendage clot and mass on aortic valve. Laboratory work-up revealed normal serum calcium. Left heart catheterisation did not reveal any significant coronary artery disease. Right heart catheterisation demonstrated severe pulmonary artery hypertension. Chest CT scan showed extensive calcification extending from left ventricular epicardium to mitral annulus (see online ).1 Median sternotomy revealed epicardial calcification but none on pericardial (figure 1). Aortic right coronary cusp mass was identified and excised through aortotomy. Left atrial appendage clot was evacuated and AtriClip (AtriCure, Cincinnati, Ohio, USA) 45 mm was applied. Mitral valve was exposed through the left atriotomy. Extensive MAC extending to the atrial wall was observed (figure 2). Anterior mitral leaflet was excised and the posterior leaflet was debrided. A 2 cm wide patch (CorMatrix Cardiovascular, Roswell, Georgia, USA) was sutured to the atrial wall next to the posterior mitral...

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