Valve repair in mitral regurgitation complicated by severe annulus calcification Choi-Keung Ng, MD, Christian Punzengruber, MD, Otmar Pachinger, MD, Joachim.

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Valve repair in mitral regurgitation complicated by severe annulus calcification Choi-Keung Ng, MD, Christian Punzengruber, MD, Otmar Pachinger, MD, Joachim Nesser, MD, Hannes Auer, MD, Herbert Franke, MD, Peter Hartl, MD The Annals of Thoracic Surgery Volume 70, Issue 1, Pages 53-58 (July 2000) DOI: 10.1016/S0003-4975(00)01347-3

Fig 1 (A) Severe mitral valve calcification with leaflets prolapse on transesophageal echocardiogram; arrow indicates annulus calcification with extension to the myocardium, chordae, and papillary muscle. (B) Calcified chordae and papillary muscle excised. (C) Calcified annulus (4.9 cm) after en bloc resection. (D) Pretreated autologous pericardial patch extended annuloplasty. The Annals of Thoracic Surgery 2000 70, 53-58DOI: (10.1016/S0003-4975(00)01347-3)

Fig 2 (a) Leaflet and atrial edge mobilized after decalcification process. (b) Technique of sliding atrioplasty: left corner shows the two layers of tissue repaired with figure of eight vertical sutures, covered later with leaflet. (c) Completion of sliding atrioplasty. (d) Semiflexible annuloplasty ring (Sculptor) after implantation. Adequate ratio of vertical and transverse annulus diameter. The Annals of Thoracic Surgery 2000 70, 53-58DOI: (10.1016/S0003-4975(00)01347-3)

Fig 3 (L) Technique of rotation paracommissural sliding plasty; after decalcification, arrow shows the direction where leaflets indentation will meet. (R) Perfect leaflet coaptation after rotation paracommissural sliding plasty. The Annals of Thoracic Surgery 2000 70, 53-58DOI: (10.1016/S0003-4975(00)01347-3)