Photomicrographs of cardiac valves with chronic rheumatic involvement (A) Diffuse fibrosis and neoformed vessels (B) Inflammatory focus composed of mononuclear cells adjacent to a thick-walled vessel (hematoxylin-eosin stain) FIG 55.15 Decalcification by crushing the calcium deposits that preferentially involve the atrial surface of the valve This may include the replacement of heavily calcified areas by autologous pericardium (Fig 55.16) FIG 55.16 Calcified segment of the anterior mitral leaflet, which was excised and replaced by fresh autologous pericardium (A) Calcified segment is picked up by the black stay sutures (B) Image obtained after excision of the calcified segment (C) The gap in the leaflet is now covered by fresh autologous pericardium Augmentation of a markedly shortened and fibrotic leaflet with autologous pericardium (Fig 55.17)