A Case Report of Mitral Valve Replacement for the Patient with Severely Calcified Mitral Annulus after Long-Term Hemodialysis

DOI 10 References
  • Adachi Katsutoshi
    Departments of Thoracic and Cardiovascular Surgery, Shingu General Medical Center Department of Surgery, Department of Thoracic and Cardiovascular Surgery, Toyooka Hospital
  • Sato Tomoaki
    Department of Surgery, Department of Thoracic and Cardiovascular Surgery, Toyooka Hospital
  • Tenpaku Hironori
    Department of Surgery, Department of Thoracic and Cardiovascular Surgery, Toyooka Hospital
  • Kajimoto Masaki
    Department of Surgery, Department of Thoracic and Cardiovascular Surgery, Toyooka Hospital
  • Makino Shigeyuki
    Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine
  • Hirano Koji
    Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine
  • Tanaka Jin
    Department of Thoracic and Cardiovascular Surgery, Mie General Medical Center
  • Okada Yukikatsu
    Department of Surgery, Department of Thoracic and Cardiovascular Surgery, Kobe City General Hospital

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Other Title
  • 高度の弁輪石灰化による僧帽弁狭窄兼閉鎖不全症をきたした慢性透析患者の１手術例

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Abstract

A 53-year-old woman underwent mitral valve replacement for congestive heart failure due to mitral stenosis and regurgitation. She had been receiving hemodialysis because of diabetic nephropathy since 1993, and had had congestive heart failure since 1999. Echocardiography demonstrated mitral stenosis (MVA; 1.10cm2) and regurgitation with a severely calcified mitral annulus. Annular calcification extended to the posterior wall of the left ventricle and the base of bilateral papillary muscles. After removing all calcium from the mitral annulus to the base of the papillary muscle, the left ventricular posterior wall and mitral annulus were reconstructed by glutaraldehyde-preserved autologous pericardium. Then, a Carbo-Medics mechanical valve was placed at the mitral annulus using everting mattress sutures. Although her hemodynamics were stable, bacteremia and multi-organ failure developed 3 months after surgery and she died. Autopsy showed that the reconstructed left ventricular posterior wall and mitral annulus using glutaraldehyde preserved autologous pericardium were in excellent condition without any thrombus. No dehiscence was found at the suture line of the mechanical valve. Mitral annulus reconstruction with glutaraldehyde preserved autologous pericardium is thought to be effective for patients with calcified mitral annulus who require mitral valve surgery.

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