Parlar A I, Cicekcioglu F, Irdem A K, Hijazi A, Altinay L, Katircioglu S F
Cardiovascular Surgery Clinic, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey.
Thorac Cardiovasc Surg. 2010 Jun;58(4):246-8. doi: 10.1055/s-0029-1240835. Epub 2010 May 31.
Traditionally, reoperations for mitral valve replacement are carried out under cardioplegic arrest with cross-clamping of the ascending aorta via a median sternotomy. In this case, the mitral valve replacement operation was performed with an on-pump beating heart technique without cross-clamping the aorta and via a right thoracotomy because of diffuse adhesions around the ascending aortic tube graft. A 44-year-old male patient had undergone a Bentall operation via a median sternotomy for annulo-aortic ectasia 3 years ago. He was admitted to the hospital complaining of palpitation and dyspnea. Transthoracic echocardiography revealed 4th degree mitral insufficiency. Mitral valve replacement was carried out through a right thoracotomy using an on-pump beating heart technique without cross clamping the aorta. In conclusion, mitral valve replacement with an on-pump beating heart technique via a right thoracotomy offers a safe approach when excessive dissection is required to place a cross-clamp to the ascending aorta.
传统上，二尖瓣置换再次手术是在心脏停搏下，通过正中胸骨切开术对升主动脉进行交叉钳夹来实施的。在本病例中，由于升主动脉人工血管周围广泛粘连，二尖瓣置换手术采用了体外循环下心脏跳动技术，未对主动脉进行交叉钳夹，而是通过右胸切口进行。一名44岁男性患者3年前因主动脉瓣环扩张经正中胸骨切开术接受了Bentall手术。他因心悸和呼吸困难入院。经胸超声心动图显示为重度二尖瓣关闭不全。通过右胸切口，采用体外循环下心脏跳动技术，未对主动脉进行交叉钳夹，实施了二尖瓣置换术。总之，当需要进行过多解剖操作才能对升主动脉放置交叉钳夹时，经右胸切口采用体外循环下心脏跳动技术进行二尖瓣置换提供了一种安全的方法。
