A 62-year old man was admitted for surgical treatment of severe aortic and mitral stenosis. He had chronic renal failure, and dialysis had started 17 years previously. Because mitral annular calcification had extensively invaded the sub-valvular apparatus (Figs 1 and 2 ), calcified mass extraction was performed using ultrasonic aspiration (Videos 1 and 2 ).
Video 1: Extraction of the mitral annular calcification using the ultrasonic aspiration system, which successfully removed the calcified mass without injuring the posterior left ventricular wall. The posterior mitral annulus was rebuilt using equine pericardium, and a mechanical prosthesis was used for mitral valve replacement.
Video 2: Preoperative and postoperative TTE. Preoperative TTE demonstrated severe mitral annular calcification and mitral stenosis. Postoperative TTE showed no mitral regurgitation and no wall-motion abnormalities. TTE: transthoracic echocardiography.
Computed tomography scan showing massive, horseshoe-shaped mitral annular calcification. White arrows indicate mitral annular calcification. ( A ) Preoperative computed tomography image (coronal view). ( B ) Postoperative computed tomography image (coronal view).
Intraoperative photos of mitral annular calcification. White arrows indicate mitral annular calcification. ( A ) Calcified matter had comprehensively invaded the posterior mitral annulus extending to the anterior and posterior commissures, the posterior leaflet and the atrial and ventricular walls. ( B ) After incision of the endocardium of the posterior mitral annulus with a surgical knife.
Conflict of interest: none declared.
