Eastern Cardiothoracic Surgical Society

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Advanced Techniques in Posterior Mitral Annulus Reconstruction
Gianluca Torregrossa, Andrea Amabile, Elbert E. Williams, John D. Puskas.
Mount Sinai St. Luke's, New York, NY, USA.

OBJECTIVE: The management of severe Mitral Annular Calcification (MAC) with a conservative approach minimizes the risk of Atrio-Ventricular (AV) groove rupture. However, patients with a history of rheumatic valve disease may present complex and mixed annular lesions requiring extensive debridement. Our technique for reconstructing the Mitral Annular Plane after mechanical decalcification is presented.
METHODS: This is a video of the surgical management of two cases of mitral valve rheumatic disease (one of which with superimposed native-valve-endocarditis) with severe MAC. After extensive Mitral Annulus debridement, the naked area of myocardium in the AV groove is covered and reinforced using a patching technique. It is important to sew the patch of autologous pericardium with a double suture line: one line down in the ventricle, the other one inside the atrium. The valvular stitches have to be passed proximally to the patch, thus de facto atrializing the position of the prosthetic mitral valve.
RESULTS: An optimal result was achieved in both cases. The double suture line avoids the risk of blood infiltrating behind the valve, into the AV groove, causing cardiac rupture.
CONCLUSIONS: Reconstructing the posterior Mitral Valve Annulus with a patch of autologous pericardium and related atrialization of the prosthetic mitral valve is a safe and feasible technique to manage severe MAC.


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