Reconstruction of a friable posterior mitral annulus after removing a calcified artificial ring using flipover technique of the anterior mitral leaflet

We report a new technique for reinforcement of a friable posterior mitral annulus using the anterior leaflet after removing a calcified artificial ring. A 72-year-old woman underwent mitral valve replacement for mitral stenosis and recurrence of regurgitation after mitral valve repair at 53 years of age. She had been on chronic hemodialysis for 20 years. The posterior mitral annulus became highly friable after débridement of the calcified artificial ring. The anterior mitral leaflet was detached from its annulus and transferred to the posterior annulus to cover the defect. The anterior leaflet was anchored to the posterior annulus by valve sutures, and mitral valve replacement was performed successfully. Postoperative ultrasonic cardiography revealed preservation of left ventricular function with no perivalvular leakage.