Mitral Valve Replacement in the Presence of Severe Valvular and Annular Calcification

Degenerative and rheumatic mitral valve disease are associated with calcification of the annulus, leaflets, and subvalvular mechanism. Surgical treatment is greatly affected by the presence of such calcification, which frequently precludes successful repair, mandating valve replacement. Dense calcification of the posterior leaflet, annulus, and chordae can cause great difficulty in the insertion of a prosthetic device, and is associated with a high frequency of technical complications. We have devised a technique of replacing the mitral valve in the face of such severe calcification, which allows the surgeon to safely insert a single disc mechanical prosthetic valve, avoiding the calcification completely. A large Teflon felt collar precludes the need to place any sutures through the posterior valve leaflet. Successful early experience with five patients, exhibiting both degenerative and rheumatic disease, is described.