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Shaikhrezai et al. Vessel Plus 2018;2:9 I http://dx.doi.org/10.20517/2574-1209.2018.17 Page 3 of 4

A B C

Figure 2. A: Closing the left ventricle by bovine pericardial patch; B: reinforcement of ventriculotomy closure by epicardium; C: mitral
valve with ring annuloplasty is satisfactorily tested

shaved off was used to cover bovine pericardial patch for haemostasis [Figure 2B].

The atrial surface of mitral valve was approached via left atriotomy. The length of neo-chordae attached to
the leaflets was accurately measured for an optimised coaptation before tying on the atrial side of the leaflets.
A flexible 31-mm annuloplasty ring (St. Jude Medical Inc, St. Paul, MN, USA) was implanted after sizing the
annulus from trigone to trigone and considering the area of anterior leaflet. The mitral valve was tested using
a cardioplegia catheter into the LV through the valve [Figure 2C]. This was confirmed following weaning
from CPB. The patient was asymptomatic at 6 weeks and 3 months follow-up with an echocardiogram
demonstrating mitral valve competence with improved LV function.

The overall cardiopulmonary bypass time was 158 min with an aortic cross clamp time of 133 min.

DISCUSSION
LV aneurysm in the context of ischemic heart disease and subsequent calcification has been reported
[4]
previously . However, there is a paucity of literature regarding the surgical treatment of calcified LV
aneurysm in a symptomatic patient with severe MR. LV aneurysm calcification can be attributed to chronic
[5]
renal failure or other hypercalcemic conditions, but this was absent in our patient. He was also suffering
from concomitant severe MR which was structurally distorted by the calcification of LV aneurysm.
Although severe MR in a symptomatic patient would be an indication for surgery, we could not ignore the
role of calcification, impairing valve function and its impact on the planned repair as without excision of
the calcified patch reimplantation of papillary muscle and subvalvular apparatus repair was not feasible.
Although concomitant mitral valve repair and excision of LV aneurysm calcification is possible with
desirable short-term results, longer follow-up is required to evaluate outcomes.

DECLARATIONS
Authors’ contributions
Performed the operation: Shaikhrezai K, Hunter S
Wrote the case report: Shaikhrezai K
Reviewed and made changes to the structure and format of the manuscript: Singh SSA
Reviewed the manuscript: Morcos K
Served as the primary supervisor of the manuscript: Hunter S

Financial support and sponsorship
None.