The Annals of Thoracic Surgery, Vol 58, 163-167, Copyright © 1994 by The Society of Thoracic Surgeons
Intraatrial insertion of a mitral prosthesis in a destroyed or calcified mitral annulus
P Nataf, A Pavie, F Jault, V Bors, C Cabrol and I Gandjbakhch
Department of Thoracic and Cardiovascular Surgery, Hopital de la Pitie, Paris, France.
Infectious lesions and extreme calcification of the mitral valve annulus
can make classic anatomic implantation of a prosthesis impossible.
Confronted with these circumstances, we have developed a technique of
intraatrial insertion of a mitral prosthesis. The prosthesis has been
modified by enlarging the circumference of the sewing ring with a Dacron
collar. The collar can be sutured to the left atrial wall above the mitral
annulus. From 1981 to 1989, this technique has been employed in 36
patients: 15 had acute valve endocarditis with destruction of the mitral
annulus and 21 had extensive annular calcification. In all cases,
circumferential or partial intraatrial insertion permitted a secure
implantation of the prosthesis. One operative death was related to the
technique. It was an intractable bleeding caused by tearing of the very
thin and fragile wall of the left atrium in a kidney transplant patient.
Four patients were reoperated on for periprosthetic leak, in 3 of whom
healing and cleaning of the mitral annulus permitted annular implantation
of a prosthetic valve. There was no ventricular wall rupture. Our results
suggest that the technique can be performed in high operative risk patients
when mitral valve replacement is impossible by conventional techniques.
