JUAN CRESTANELLO: Welcome to the Cardiovascular Surgery Series where I review the latest research in cardiovascular surgery from the Mayo Clinic in just two minutes. I am Dr. Juan Crestanello. I am a cardiac surgeon at the Mayo Clinic in Rochester, Minnesota.

In this commentary titled, Seal the Calcium, we continue to analyze the diagnostic and technical challenges associated with mitral valve replacement in patients with severe mitral annular calcification. First, patient with MAC have significant diastolic dysfunction and left atrial noncompliance that can lead to increase transmitral gradients. It is therefore important to confirm the diagnostic of mitral stenosis on those patients with invasive hemodynamic studies.

The appropriate evaluation with cardiac CTA is important to evaluate the risk of left ventricular outflow tract obstruction, as well as the location of the circumflex coronary artery. Finally, the direct transatrial mitral valve replacement with a modified SAPIEN valve is an alternative in patients with massive mitral annular calcification. This approach has several advantages.

One, it allows for a radial force of the stent to secure the valve in place minimizing the need for regular stitches through the calcified annulus. Two, it allows for the resection of the anterior leaflet of the mitral valve minimizing the risk of left ventricular outflow tract obstruction. And three, it allows for the performance of a septum myectomy to further open the [INAUDIBLE] if necessary. However, most patients can be treated with a conventional mitral valve prostheses.

Thank you for listening to the Mayo Clinic Cardiovascular Surgery Series.