Hazards of Mitral Valve Replacement for Mitral Stenosis Caused by Massive Mitral Annular Calcium With or Without Aortic Valve Replacement for Aortic Stenosis.

Mitral annular calcium (MAC) is common in older adults in the Western World and if extensive may cause mitral stenosis . The purpose of this report is to describe outcomes of 12 patients having mitral valve replacement for mitral stenosis secondary to massive MAC. Operatively excised deposits of calcium removed from the mitral annular area and the accompanying stenotic mitral valves were examined and then the patients' medical records were examined to confirm the diagnosis and the degree of valvular dysfunction. A total of 12 patients with massive MAC causing mitral stenosis and receiving mitral valve replacement with or without aortic valve replacement for aortic stenosis were observed in 2013 to 2015. Of the 12 patients, 7 died from 5 to 44 days (mean 19) after the valve operation and all had "stormy" postoperative courses; one survived 150 days and another, 600 days; the remaining 3 were improved by the operation and are alive 22, 27, and 59 months postoperatively. In conclusion, the high mortality in these patients suggests that mitral valve replacement in the setting of massive MAC be considered with caution.