Reconstructive surgery of an extremely calcified mitral valve in a Barlow disease patient: A case report

Abstract

Introduction. Mitral valve calcifications are frequent finding in Barlow disease. This is making mitral repair surgery even more demanding in already complex valve pathology. Case report. A fifty-five-year-old Barlow disease patient underwent a mitral repair surgery due to posterior leaflet prolapse at P2 level and extensive posterior leaflet and annular calcifications as well. The prolapsed scallop was resected, while P1 and P3 scallops were detached from the annulus. After complete posterior annulus decalcification, so formed the large atrio-ventricular defect was reconstructed with the autologous pericardial patch and double suture line technique. The P1 and P3 segments were reattached there by the sliding technique and sutured with no strain. Annuloplasty was performed with a saddle rigid ring No 36. The patient was discharged nine days after the surgery with just a trace of mitral regurgitation. Conclusion. Annular decalcification and reconstruction in the patients with calcified Barlow mitral disease is necessary for safe and durable mitral valve surgical repair.

Uvod. Kalcifikacije mitralne valvule su čest nalaz kod bolesnika sa Barlovljevom bolesti što čini rekonstruktivnu hirurgiju zalistka kod ovih bolesnika znatno složenijom. Prikaz bolesnika. Bolesniku starom 55 godina je urađena rekonstrukcija mitralnog zalistka zbog prolapsa posteriornog listića i značajnih kalcifikacija na P2 segmentu i posteriornom anulusu. Nakon resekcije P2 segmenta i odvajanja P1 i P3 segmenta od anulusa, urađena je kompletna resekcija velikog kalcifikata sa skoro polovine obima posteriornog anulusa. Nastali atrioventrikularnog defekt rekonstruisan je autolognim perikardom elipsoidnog oblika sašivenim u dva sloja. P1 i P3 segment su potom reinplantirani na rekonstruisani anulus i međusobno spojeni. Rekonstruktivna procedura je kompletirana anuloplastikom pomoću sedlastog rigidnog prstena veličine 36. Bolesnik je otpušten devetog postoperativnog dana sa neznatnom mitralnom regurgitacijom. Zaključak. Dekalcifikacija posteriornog anulusa uz preciznu rekonstrukciju nastalog atrioventikularnog defekta je neophodna procedura za bezbednu i funkcionalno trajnu rekonstrukciju mitralnog zalistka.