Mitral Valve Surgery in Patients With Severe Mitral Annular Calcification Tomoya Uchimuro, MD, Toshihiro Fukui, MD, Atsushi Shimizu, MD, Shuichirou Takanashi,

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Mitral Valve Surgery in Patients With Severe Mitral Annular Calcification Tomoya Uchimuro, MD, Toshihiro Fukui, MD, Atsushi Shimizu, MD, Shuichirou Takanashi, MD The Annals of Thoracic Surgery Volume 101, Issue 3, Pages 889-895 (March 2016) DOI: 10.1016/j.athoracsur.2015.08.071 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Schematic diagram of the mitral valve repair. (A) Mitral valve with posterior leaflet prolapse and severe annular calcification. (B) Prolapsed leaflet was resected, and annular calcification was removed. (C) The annulus was reconstructed using the pericardium. (D) The posterior leaflet was reattached. (E) A prosthetic ring was placed at the annulus. The Annals of Thoracic Surgery 2016 101, 889-895DOI: (10.1016/j.athoracsur.2015.08.071) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Schematic diagram of the mitral valve replacement. (A) Mitral valve with severe annular calcification. (B) Valve leaflets and annular calcification were removed completely. (C) The annulus was reconstructed using the pericardium. (D) Noneverted horizontal mattress sutures were placed at the annulus. (E) The prosthetic valve was secured at the supraannular position. The Annals of Thoracic Surgery 2016 101, 889-895DOI: (10.1016/j.athoracsur.2015.08.071) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Kaplan–Meier survival curves. (A) Survival from all-cause death. (B) Survival from cardiac death. (C) Freedom from major adverse valve-related events. (D) Freedom from reoperation. The Annals of Thoracic Surgery 2016 101, 889-895DOI: (10.1016/j.athoracsur.2015.08.071) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions