Andersons pediatric cardiology 1471

Photomicrographsofcardiacvalveswithchronic
rheumaticinvolvement.(A)Diffusefibrosisandneoformed
vessels.(B)Inflammatoryfocuscomposedofmononuclearcells
adjacenttoathick-walledvessel(hematoxylin-eosinstain).
FIG.55.15

6.Decalcificationbycrushingthecalciumdepositsthatpreferentially
involvetheatrialsurfaceofthevalve.Thismayincludethereplacement
ofheavilycalcifiedareasbyautologouspericardium(Fig.55.16).



FIG.55.16 Calcifiedsegmentoftheanteriormitralleaflet,which
wasexcisedandreplacedbyfreshautologouspericardium.(A)
Calcifiedsegmentispickedupbytheblackstaysutures.(B)
Imageobtainedafterexcisionofthecalcifiedsegment.(C)The
gapintheleafletisnowcoveredbyfreshautologous
pericardium.

7.Augmentationofamarkedlyshortenedandfibroticleafletwith
autologouspericardium(Fig.55.17).