Edge-to-Edge Repair After Prior Left-Sided Pneumonectomy

Abstract

Cardiac surgery procedures for patients following previous pneumonectomy are challenging because of anaesthetic and cardio-surgical technical difficulties. Here, the case of a patient who had received a left-sided pneumectomy 13 years prior as a result of nonsmall cell lung cancer is presented. A mitral edge-to-edge clipping was applied with excellent success in treating severe mitral regurgitation attributable to flail of the posterior mitral valve leaflet (fibroelastic deficiency). Because the heart was severely left-displaced, the use of transoesophageal echo during the preinterventional screening was challenging but feasible, and imaging quality was good. The absence of left pulmonary veins demanded a guide catheter and clip delivery system to be introduced during the procedure through the use of a spiral, preshaped, stiff guidewire. The procedure was performed under general anaesthesia with the patient extubated on a table. No complications arose during the periprocedural period and hospital stay, and after 3 months’ follow-up the patient showed significant functional improvement.