Mitral Valve Replacement via Right Thoracotomy for Ischemic Mitral Regurgitation in a Patient with Prior Coronary Artery Bypass Grafting

Chikara Ueki

Genichi Sakaguchi

Takehide Akimoto and Tsunehiro Shintani

（Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan）

We report a case of redo mitral valve replacement via right thoracotomy for ischemic mitral regurgitation after coronary artery bypass grafting. An 81-year-old woman with a history of multiple coronary artery bypass grafting was admitted to our institute for treatment of severe ischemic mitral valve regurgitation. She had a history of repeated hospitalization for heart failure and complained of worsening dyspnea. Coronary angiography showed patent coronary grafts. Echocardiography revealed severe mitral regurgitation with leaflet tethering and posteroinferior wall asynergy. The patient underwent mitral valve replacement（Mosaic Bioprosthesis 27mm）via right thoracotomy approach with ventricular fibrillation under moderate hypothermia. The ventricular fibrillation time was 57 min, and the cardiopulmonary bypass time was 126 min. The patient’s postoperative recovery was uneventful. She was discharged on postoperative day 19. Right thoracotomy approach provided excellent exposure of the mitral valve and minimized the risk of repeat sternotomy, including injury of previous bypass grafts, injury of right ventricle and significant hemorrhage.

 

Jpn. J. Cardiovasc. Surg. 43:313-317（2014）

Keywords：redo surgery;ischemic mitral regurgitation;right thoracotomy;mitral valve replacement