Elsevier

The American Journal of Cardiology

Volume 189, 15 February 2023, Pages 131-136
The American Journal of Cardiology

Mitral Valve Replacement for Mitral Stenosis Secondary to Massive Mitral Annular Calcium

https://doi.org/10.1016/j.amjcard.2022.11.003Get rights and content

Mitral annular calcium (MAC) may produce mitral stenosis (MS) if its quantity is massive. We define massive MAC as the presence of a huge quantity of calcium underlying the posterior mitral leaflet and extending across all or nearly all of the ventricular aspect of the anterior mitral leaflet. This report was prompted to emphasize the hazards of performing mitral valve replacement in patients with MS secondary to massive MAC. The clinical data and morphology of the operatively excised mitral valves from the 11 patients who had mitral valve replacement for MS secondary to massive MAC are described. Of the 11 patients, 6 died postoperatively, 5 of whom had 4+/4+ MAC. The high mortality in these patients suggests that the decision to perform mitral valve replacement needs to be carefully considered if the quantity of MAC is massive.

Section snippets

Patients Studied

Since March 1993, one of us (WCR) has examined, described, and submitted the report on all surgical specimens excised by cardiac surgeons at Baylor University Medical Center (BUMC). From January 2016 to April 2022, portions of the mitral valve in 215 patients were submitted to the surgical pathology unit of the department of Pathology at BUMC (Figure 1). Of the 215 patients, 52 (24%) had mitral valve repair for pure mitral regurgitation, and 163 (76%) had mitral valve replacement. Of the latter

Results

Pertinent clinical and morphologic findings in the 11 patients are summarized in table 1. The ages at the time of the mitral valve replacement ranged from 37 to 83 years (median 70); 6 were women and 5 were men. Preoperatively, the mean gradient between left atrium and left ventricle ranged from 9 to 15 mmHg (average 12). Four patients had renal replacement therapy due to chronic kidney disease and 3 patients had coronary revascularization. Three patients had atrial fibrillation. Four patients

Comment

The purpose of this article is to again emphasize the potential dangers of replacing a mitral valve made stenotic by massive MAC. In a previous study1 on this topic the mortality following this procedure was high, and as the Tirone E. David group has emphasized the results of replacing and/or repairing the mitral valve in the setting of “extensive” MAC is 6.2 times higher than that occurring in patients having mitral valve procedures at their institution without MAC.2,3 Even in their patients

Declaration of interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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