Extensive calcification of the mitral valve annulus in transcatheter aortic valve implants

 Open in a separate windowOBJECTIVESThis study sought to report the calcification pattern of the mitral valve annulus and its implications for procedural and safety outcomes in transcatheter aortic valve implantation.METHODSBetween November 2018 and September 2019, a total of 305 patients had transcatheter aortic valve implants at our institution. The extent of calcification of the mitral valve annulus was analysed, and the impact on safety outcomes was evaluated.RESULTSThe prevalence of mitral annular calcification (MAC) was 43%. Calcification of the mitral valve annulus was either less than or at least one-third of the posterior annulus (34% and 32%), the whole posterior annulus (28%) or the extension to the attachment of the anterior leaflets (7%). Severe circumferential MAC revealed moderate paravalvular leaks in 5/8 (63%) patients and was associated with right branch bundle block [odds ratio (OR) 2.01 (0.39–3.06); P = 0.098] and low cardiac output [OR 3.12 (1.39–7.04); P = 0.033]. Subannular calcification at the anterolateral trigonum represented a risk factor for left ventricular outflow tract injury [OR 3.54 (1.38–8.27); P = 0.001] in balloon-expandable valves, associated with relevant rhythm disorders [OR 2.26 (1.17–5.65); P = 0.014] and female gender (7/8, 88%). The 30-day all-cause mortality in circumferential MAC reaching into the anterior annulus (grade IV) compared to patients with less MAC (grade I–III) was 13% vs 2% with a mean valve size of 24.6 vs 25.7 mm.CONCLUSIONSExtensive MAC was associated with moderate paravalvular leaks, with implications for the prosthesis size and survival in transcatheter aortic valve implants. In severe MAC, we recommend implanting oversized self-expandable prostheses, the goal being to reduce the risk of right branch bundle block and paravalvular leaks.Subj collection122, 125     

Severe mitral systolic anterior motion complicating aortic valve replacement

This case illustrates a severe dynamic left ventricular outflow obstruction after aortic valve replacement (AVR). This phenomenon is little recognised but probably occurs more frequently than appreciated, and should be considered when managing patients with severe haemodynamic instability after AVR. The possible mechanisms and treatment are discussed.     

An experience of a case with perforation of an aneurysm in the anterior mitral cusp developing after aortic valve replacement.

Mitral valve aneurysm is a rare disease and in Japan, cases of perforation which is considered to be mainly caused by infectious endocarditis is usually only encountered through case reports. We experienced a case who received aortic valve replacement and mitral valve annuloplasty for combined valvular heart disease of aortic insufficiency and mitral insufficiency followed by mitral valve replacement for severe mitral valve regurgitation subsequent to perforation of the anterior mitral cusp, leading to recovery.     

Systolic anterior motion of the mitral valve and severe mitral regurgitation immediately after transcatheter aortic valve replacement

We report a high-risk patient with severe symptomatic aortic stenosis who showed systolic anterior motion of the mitral valve (SAM) and severe mitral regurgitation immediately after transcatheter aortic valve replacement (TAVR). The patient did not have either SAM or mitral regurgitation, but showed significant septal hypertrophy on preoperative transthoracic echocardiography which could be associated with the occurrence of SAM. Caution should be exercised in patients with significant interventricular septal hypertrophy before TAVR.     

Cardiac conduction defects associated with aortic and mitral valve calcification in dialysis patients

The prevalence of aortic valve and mitral valve or mitral annular calcification by echocardiography was studied in 66 dialysis patients and correlated with results of 24-h ambulatory and resting ECG data and 12-month survival. The well-known association of mitral valve or mitral annular calcification with cardiac conduction defects was confirmed. Those patients with mitral valve or mitral annular calcification demonstrated a higher prevalence of first-degree atrioventricular block and bundle branch block. Despite advanced age and these conduction defects, those patients with mitral valvular calcification did not show decreased survival at 12 months.     

Dysplastic aortic valve with absence of aortic valve cusp: an unreported cause of congenital aortic insufficiency

Three patients are described in whom dysplasia of the aortic valve was associated with total absence of one of the semilunar aortic cusps and congenital aortic insufficiency. Two of the three survived aortic valve replacement.     

Case of systolic anterior motion of mitral valve after mitral valve repair

A 56-year-old woman was underwent mitral valve repair for prolapse of the posterior mitral leaflet. Intraoperative transesophageal echocardiography (TEE) showed systolic anterior motion (SAM) of the mitral valve at the weaning from cardiopulmonary bypass (CPB). Sliding technique was easily performed at the second pump run. Intraoperative TEE demonstrated no SAM or residual mitral regurgitation after the second pump run.     

Testing of mitral valve competence following combined mitral valve repair and aortic valve replacement

A simple, effective technique for testing the results of repair and reconstructive procedures on the mitral valve apparatus is described. This technique can be used in the operative setting of combined aortic valve replacement and mitral valve repair where other reported techniques for testing the valve apparatus are rendered unfeasible.     

Valvuloplasty for aortic valve regurgitation resulting from cusp prolapse

Three adults, 2 with tricuspid aortic valve and 1 with bicuspid valve, underwent valvuloplasty for aortic valve regurgitation resulting from cusp prolapse. Surgical procedures consisted of combined cusp plication by triangular cusp resection and subcommissural annuloplasty. Doppler echocardiography revealed trivial aortic valve regurgitation intraoperatively and less than I/IV at discharge in all cases. After mean follow-up of 15 months, 2 tricuspid aortic valve patients remain I/IV regurgitation and II/IV in the bicuspid patient. Although long-term results remain unclear, our results show that this procedure is feasible and beneficial in patients with aortic valve regurgitation due to cusp prolapse.     

Edge-to-edge mitral valve repair for anterior leaflet prolapse associated with extensive calcification of the mitral annulus: Report of a case

Extensive mitral annular calcification remains a technical challenge in mitral valve surgery. Decalcification and reconstruction of the mitral annulus is an established technique, but it is time consuming and technically demanding. This report presents the case of an 88-year-old diabetic female patient in whom edge-toedge repair was completed quickly, with good early results thus being obtained.