A Patient Who Underwent Mitral Annuloplasty for Mitral-Valve Insufficiency due to Calcification of the Mitral-Valve Annulus

(Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan and First Department of Surgery, Yokohama City University*, Yokohama, Japan)

Tomoyuki Minami Kiyotaka Imoto Shin-ichi Suzuki
Keiji Uchida Norihisa Karube Koichiro Date
Motohiko Goda Toshiki Hatsune Munetaka Masuda*
A 74-year-old woman presented with shortness of breath. Cardiac ultrasonography showed that left-ventricular-wall motion was good (left ventricular ejection fraction, 70.2%). The left atrium and ventricle were enlarged (left anterior dimension, 53.4mm; left ventricular end-diastolic dimension, 58.5mm). The posterior cusp of the mitral valve was thickened; the flexibility was decreased. Color Doppler ultrasonography revealed a regurgitant jet toward the posterior cusp of the left atrium. However, there was no deviation of the anterior cusp. Severe mitral-valve insufficiency was diagnosed, and surgery was performed. The second heart sound (P2) of the posterior cusp was shortened because of localized calcification of the posterior mitral annulus. This site may have caused the regurgitation. Mitral annuloplasty with rectangular resection of the valve cusps and annulorrhaphy was performed. The patient had an uneventful recovery after surgery. Postoperative cardiac ultrasonography showed that mitral-valve insufficiency had improved and was regarded as trivial. Mitral annuloplasty is generally considered unsuitable for mitral-valve insufficiency with calcification of the valve annulus. In patients such as the present case who have localized calcification, however, mitral annuloplasty can be performed by resection of the valve cusps with annulorrhaphy.
@Jpn. J. Cardiovasc. Surg.36: 333-336 (2007)