Beating heart mitral valve repair for a patient with previous coronary bypass: a case report and review of the literatur
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CASE REPORT
Open Access
Beating heart mitral valve repair for a patient with previous coronary bypass: a case report and review of the literature Teruya Nakamura1*, Hironori Izutani2, Naosumi Sekiya1, Taro Nakazato1 and Yoshiki Sawa3
Abstract Mitral valve reoperation, through a median sternotomy, for a patient with patent coronary bypass grafts is technically challenging and carries higher postoperative morbidity and mortality than a primary operation. We present a case of mitral valve repair using a beating heart technique under normothermic cardiopulmonary bypass that was performed 3 years after a coronary artery bypass operation. A limited (10 cm) right thoracotomy was made and cardiopulmonary bypass was conducted using the ascending aortic and femoral venous cannulation. The left atrium was opened while beating was maintained. Triangular resection of the prolapsed portion of the posterior leaflet and ring annuloplasty were performed. Completeness of the repair was verified by direct visualization under beating condition and transesophageal echocardiogram. This technique is a safe and feasible option for a mitral valve reoperation that excludes re-sternotomy, extensive pericardial dissection and aortic clamping, thereby minimizes risks of bleeding, graft injury and myocardial damage. Keywords: Mitral valve insufficiency, Mitral valve repair, Reoperation, Minimally invasive surgical procedures
Background The number of patients undergoing cardiac reoperations continues to increase. Redo procedures usually involve sternal reentry, which has the potential for hazardous injuries to the important structures and subsequent morbidity and mortality [1]. In the case of a patient who has poor ventricular function for a long-standing valve disease, cardiac arrest may predispose the dilated myocardium to ischemia-reperfusion injury and postoperative low cardiac output [2]. We describe a case in which we performed a redo mitral valve repair after coronary bypass surgery using a beating heart approach via a limited right thoracotomy. Advantages and disadvantages of the procedure are discussed. Case presentation A 76-year-old Japanese male who underwent quadruple coronary artery bypass surgery 3 years before had deve* Correspondence: [email protected] 1 Division of Cardiovascular Surgery, National Hospital Organization Kure Medical Center/Chugoku Cancer Center, 3-1 Aoyama-Cho, Kure 737-0023, Japan Full list of author information is available at the end of the article
loped shortness of breath, and visited our clinic for checkups. His postoperative course was significant for mediastinal wound infection, which was treated by local debridement and antibiotics. Upon examination, a loud systolic murmur was noted at the apical area. Chest roentgenogram showed mild cardiomegaly. Electrocardiogram showed sinus rhythm and no evidence of myocardial ischemia. Echocardiogram demonstrated severe mitral regurgitation due to torn chorda of the posterior leaflet (P2), which was not noted at the initial operation (Figure 1A, B). Otherw
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