Surgical techniques for the management of the 'hostile mitral annulus'.

The mitral annulus can be rendered hostile by several uncommon clinical situations such as infective endocarditis, calcification, or previous valve surgery. These can all lead to difficulties seating a prosthesis or annuloplasty ring. The posterior mitral annulus or anteriorly the intervalvar fibrous body can be affected.

Mitral valve repair for advanced myxomatous degeneration with posterior displacement of the mitral annulus.

Objective: This study examines the outcomes of mitral valve repair in a defined group of patients with mitral regurgitation caused by advanced myxomatous degeneration.

Methods: Advanced myxomatous degeneration of the mitral valve was defined as a degenerative process whereby both leaflets are voluminous and aneurysmal and the mitral annulus diameter exceeds 40 mm and has posterior displacement, as determined by means of echocardiographic analysis. Over a 16-year period, we identified 183 patients who underwent valve repair in this subgroup of myxomatous degeneration.