Porcelain Aorta and Radiation-Induced Mitral Annular Calcification Are Not Contraindications to Surgery

Figures

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  Figure 1. Transthoracic Echocardiography of the Mitral Valve in Diastole Extensive mitral annular and leaflet calcification in the (A) parasternal long-axis, (B) parasternal short-axis, and (C) apical 4-chamber views. Flow acceleration across the mitral valve (MV) in diastole (with concomitant aortic regurgitation) in the (D) parasternal long-axis and (E) apical 4-chamber views, consistent with (F) severe mitral stenosis. Max = maximum; MVA = mitral valve area; PG = pressure gradient; V = velocity; VTI = velocity time integral.

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  Figure 2. Gated Cardiac Computed Tomography (A) Fibrotic aortic valve leaflets and subannular calcification protruding into the left ventricular outflow tract and along the aortomitral continuity (transcatheter aortic valve replacement deployment likely to result in suboptimal valve expansion), and (B) extensive mitral annular calcification.

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  Figure 3. Computed Tomography 3-Dimensional Rendered Image Nearly circumferential calcification of the aorta extending from the proximal ascending root to the distal arch.

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  Figure 4. Postoperative Transthoracic Echocardiography in Systole (A) No residual mitral regurgitation and 2 washing jets with (B to D) satisfactory mitral and aortic transvalvular gradients. AV = aortic valve; AVA = aortic valve area; BSA = body surface area; LVOT = left ventricular outflow tract; SV = stroke volume; VR = velocity ratio; other abbreviations as in Figure 1.