Valve replacement via upper partial sternotomy for quadricuspid aortic valve
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CASE REPORT
Valve replacement via upper partial sternotomy for quadricuspid aortic valve Yukiharu Sugimura • Masanori Katoh • Takashi Murakami • Yuji Kato • Masaaki Toyama
Received: 25 April 2012 / Accepted: 24 October 2012 / Published online: 1 November 2012 Ó The Japanese Association for Thoracic Surgery 2012
Abstract A 52-year-old man was referred to our clinic because of chronic heart failure. A Levine 3/6 diastolic heart murmur was audible at the apex. Chest radiography showed an enlarged left ventricle. Transthoracic echocardiography showed moderately severe aortic regurgitation. Left ventricular end-diastolic/systolic diameter and ejection fraction were 75/59 mm and 41 %, respectively. Preoperative transesophageal 3-dimensional echocardiography revealed a quadricuspid aortic valve whose cusps were of almost equal size. Aortic valve replacement was performed via upper partial sternotomy. Keywords Quadricuspid aortic valve Upper partial sternotomy Valve replacement Introduction Quadricuspid aortic valve (QAV) is extremely rare in patients with normal development. We report a case of QAV with aortic regurgitation (AR) corrected using a prosthetic valve. Case The patient was a 52-year-old man whose first clinical symptom was dyspnea. Thirty years before he presented to Y. Sugimura (&) M. Katoh Department of Cardiovascular Surgery, Fuji Heavy Industries Health Insurance Society Ota Memorial Hospital, 455-1 Oshima-cho, Ota, Gunma 373-8585, Japan e-mail: [email protected] T. Murakami Y. Kato M. Toyama Department of Cardiovascular Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba 296-8602, Japan
our clinic, he was informed that he had a heart murmur, but he had not been followed up. Chest radiography showed mild cardiomegaly. Electrocardiography indicated sinus rhythm and left ventricular hypertrophy. A transthoracic echocardiogram showed moderately severe AR. No aortic stenosis was found. Left ventricular end-diastolic/systolic diameter and ejection fraction were 75/59 mm and 41 %, respectively. Coronary computed tomography indicated normal location of coronary artery ostia. Coronary angiography revealed no stenosis. Preoperative transesophageal echocardiography revealed a QAV with a central jet of AR; the QAV had cusps of almost equal size and sufficient coaptation height (Fig. 1). No other congenital anomaly was evident. Surgical treatment was planed. A 9-cm mini-incision was made on the skin, and an upper partial sternotomy was performed in the right fourth intercostal space. The ascending aorta was cannulated, and a two-stage venous cannula was inserted into the right atrium. A left ventricular vent was placed through the right superior pulmonary vein. The aorta was cross-clamped, and only antegrade cardioplegia was induced throughout the operation. The patient’s body was cooled to 32 °C. Transverse aortotomy was performed, and the aortic valve was exposed (Fig. 2). The valve consisted of almost four equal cusps with no raphe, prolapse, or calcification, but the margin of each le
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