How to Replace a Severely Calcified Mitral Valve

In this video, Dr. Vince Gaudiani demonstrates how to replace a mitral valve that is severely calcified in both the anterior and posterior leaflets. 

Before the procedure began, the echocardiogram and angiogram were reviewed, clearly showing the heavily calcified mitral valve and its relationship to the circumflex coronary artery.  

The operation began with femoral venous cannulation, followed by direct aortic cannulation. Both antegrade and retrograde cardioplegia were used for this case, which tended to take longer than a usual mitral valve replacement. The aorta was slung and elevated to allow for a rooftop incision in the left atrium, providing an excellent view of the mitral valve. The anterior leaflet was partially cut away and then used to pull the annulus down, making suture placement easier.  

Next, the posterior leaflet was partially excised, and an orthopedic toothed rongeur was used to debride much of the calcium. Once an adequate amount of calcium was removed and the sutures were in place, the valve was parachuted into position, tied into place, and the operation was completed. 

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