Mitral valve replacement with St. Jude Medical mechanical heart valve in severely calcified mitral annulus; a simple and novel technique

A 63-year-old woman who had been on hemodialysis for 20 years was referred to our institution to undergo mitral valve surgery for mitral valve stenosis. Intraoperative investigations confirmed severe calcification of the mitral leaflets and mitral annulus. We excised the only anterior leaflet, but preserved the posterior leaflet to prevent a fatal complication such as posterior left ventricular rupture or injury of the coronary artery. We passed 2-0 polyester mattress sutures through the anterior mitral annulus from the left ventricle to the left atrium, and then folded the posterior leaflet. Preserved posterior leaflet was fixed to posterior mitral annulus and prosthetic valve. The mitral valve was replaced using a St. Jude Medical mechanical heart valve with a specific structure, whose hinge shifts to the left atrial side and most of the leaflet to move its housing. This particular structure enables to perform this procedure without the need for excision of a severely calcified posterior mitral leaflet and annulus.