A One-Stage Operation for Incomplete AVSD, Mitral Regurgitation, Patent Foramen Ovale, Atrial Fibrillation, and Pectus Excavatum

Takao Miki＊	Toru Takahashi＊	Jun Mohara＊
Masanori Koike＊	Izumi Takeyoshi＊

（Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan）

A 55-year-old man presented with exertional dyspnea. He was found to have an incomplete atrioventricular septal defect（AVSD), mitral regurgitation, a patent foramen ovale（PFO), atrial fibrillation, and pectus excavatum. A one-stage operation including thoracoplasty in addition to the intracardiac repair was preferred in order to obtain a good view of the operative field and control the postoperative hemodynamics. Therefore, we performed autologous pericardial patch closure of the AVSD, mitral valve plasty with closure of the mitral cleft, direct closure of the PFO, and a modified maze procedure, followed by sternal elevation（modified Ravitch procedure）during chest closure. Postoperatively, his respiratory status on a respirator improved slowly and he was extubated on the 17th postoperative day. Dysphagia developed because of the prolonged intubation, but improved with deglutition rehabilitation. The subsequent postoperative course was uneventful and he was discharged on the 59th postoperative day. We performed a modified Ravitch procedure, instead of sternal turnover, because the latter requires exfoliating a broad area, which could increase the total blood loss and the risk of infection, and make it difficult to maintain the blood flow of the plastron. We obtained a good view of the operative field and stable hemodynamics postoperatively with sternal elevation in pectus excavatum accompanied by heart disease.

 

Jpn. J. Cardiovasc. Surg. 45:161-165（2016）

Keywords：incomplete AVSD;pectus excavatum;sternal elevation;one-stage operation