Simultaneous beating-heart mitral valve replacement and aortic repair following Bentall procedure via double right mini-thoracotomies: a case report.

Toshimasa Tanaka, Takeshi Kinoshita, Daisuke Endo, Minoru Tabata
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Abstract

Background: Redo mitral valve surgery by re-sternotomy approach has challenges such as bleeding and organ injury due to adhesion dissection, sternal bone infection, and poor field of view of mitral valve. On the other hand, redo mitral valve surgery via a right mini-thoracotomy approach appears to address these challenges. We successfully performed a double right mini-thoracotomies approach for mitral valve replacement and pseudoaneurysm repair under the beating-heart condition. Herein, we report the effectiveness and the safety of this technique and detailed procedure.

Case presentation: The patient is a 71-year-old man with a history of Bentall procedure using a mechanical valve at another hospital 30 years ago. He developed acute heart failure due to severe mitral valve regurgitation. After medication, he was referred to our department for the purpose of surgery for mitral valve regurgitation. Preoperative transesophageal echocardiography showed extensive degenerative change of the both leaflets and chordae tendineae rupture at the P3 segment. Both left atrium and ventricle dilated, and left ventricle contractility reduced. Aortic mechanical valve had no problem. In addition, preoperative contrast enhanced computed tomography revealed a pseudoaneurysm at the distal anastomotic site of Bentall procedure. We performed mitral valve replacement by mechanical valve and repair of distal anastomotic cite under beating heart condition, utilizing a double right mini-thoracotomies approach for mitral valve and ascending aortic pseudoaneurysm respectively. The postoperative course was uneventful, the patient was discharged without complications.

Conclusion: The right mini-thoracotomies approach efficiently accessed mitral valve and ascending aorta in reoperations, reducing the adhesion dissection risks and ensuring clear exposure. Moreover, concomitant use of beating-heart technique minimized adhesion dissection for aortic cross-clamp, preserved cardiac function.

通过双右小胸腔切口进行 Bentall 手术后同时进行心脏搏动二尖瓣置换和主动脉修补术:病例报告。
背景:通过再胸骨切开术方法重做二尖瓣手术存在一些挑战,如粘连剥离导致的出血和器官损伤、胸骨感染以及二尖瓣视野不佳。另一方面,通过右侧小胸腔切口方法重做二尖瓣手术似乎可以解决这些难题。我们在心脏搏动条件下成功实施了双右小胸腔切口二尖瓣置换和假性动脉瘤修补术。在此,我们报告了这一技术的有效性和安全性以及详细的手术过程:患者是一名 71 岁的男性,30 年前曾在另一家医院使用机械瓣膜进行过 Bentall 手术。由于二尖瓣严重返流,他出现了急性心力衰竭。经过药物治疗后,他被转诊到我科,准备接受二尖瓣反流手术。术前经食道超声心动图显示,两瓣叶广泛退行性改变,P3段腱索断裂。左心房和左心室扩张,左心室收缩力减弱。主动脉机械瓣没有问题。此外,术前造影剂增强计算机断层扫描显示,在 Bentall 手术的远端吻合处有一个假性动脉瘤。在心脏跳动的情况下,我们采用右小胸腔双切口方法分别为二尖瓣和升主动脉假性动脉瘤患者实施了二尖瓣机械瓣膜置换术和远端吻合口引线修复术。术后过程顺利,患者无并发症,顺利出院:结论:在再手术中,右小胸腔切口方法能有效进入二尖瓣和升主动脉,降低粘连夹层风险,确保清晰暴露。此外,同时使用搏动心技术可最大限度地减少主动脉交叉钳夹的粘连夹层,保护心脏功能。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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