A Case of Aortic Valve Replacement through Right Anterior Mini-thoracotomy in a Patient with a History of Mediastinal Abscess

Shuto Tonoki＊	Hiroaki Takahashi＊	Yasuko Gotake＊
Takaki Sugimoto＊

（Hyogo Prefectural Awaji Medical Center＊, Sumoto, Japan）

A 67-year-old woman had aseptic mediastinal abscess during oral steroids treatment for myelodysplastic syndrome（MDS）and Tolosa-Hunt syndrome 15 years ago, and underwent left thoracotomy drainage. The postoperative wound was ulcerated and was diagnosed with pyoderma gangrenosum. She had heart failure symptoms and was diagnosed with severe aortic valve regurgitation（AR）two years ago. Although surgery was indicated at another hospital, they judged that the risk of complications including wound infection and mediastinal abscess was high, and the patient was followed up with medical therapy. However, the symptoms of heart failure gradually worsened, and we planned aortic valve replacement through right anterior mini-thoracotomy. Her postoperative course was unremarkable, and she underwent extubation on the day of the operation and was discharged 12 days postoperatively without complications. We suggest that the right small thoracotomy approach will be useful for patients at high risk of mediastinal abscess and wound infection.

 

Jpn. J. Cardiovasc. Surg. 50:383-386（2021）

Keywords：mediastinal abscess;right anterior mini-thoracotomy;aortic valve replacement;MICS