Sapien XT Transcatheter Mitral Valve Replacement Under Direct Vision in the Setting of Significant Mitral Annular Calcification Takashi Murashita, MD,

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Sapien XT Transcatheter Mitral Valve Replacement Under Direct Vision in the Setting of Significant Mitral Annular Calcification Takashi Murashita, MD, Rakesh M. Suri, MD, DPhil, Richard C. Daly, MD The Annals of Thoracic Surgery Volume 101, Issue 3, Pages 1171-1174 (March 2016) DOI: 10.1016/j.athoracsur.2015.05.048 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Preoperative transthoracic echocardiography showed severe calcified mitral stenosis and mitral annular calcification. The Annals of Thoracic Surgery 2016 101, 1171-1174DOI: (10.1016/j.athoracsur.2015.05.048) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Intraoperative photograph showed severe mitral annular calcification. The Annals of Thoracic Surgery 2016 101, 1171-1174DOI: (10.1016/j.athoracsur.2015.05.048) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 The 29-mm Sapien XT valve was implanted and expanded with the balloon under direct visualization. The Annals of Thoracic Surgery 2016 101, 1171-1174DOI: (10.1016/j.athoracsur.2015.05.048) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Satisfactory positioning and stability were obtained. A water test showed minimal periprosthetic leakage. The Annals of Thoracic Surgery 2016 101, 1171-1174DOI: (10.1016/j.athoracsur.2015.05.048) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Postoperative transthoracic echocardiography showed only trivial mitral valve periprosthetic regurgitation. The Annals of Thoracic Surgery 2016 101, 1171-1174DOI: (10.1016/j.athoracsur.2015.05.048) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions