Nishigawa Kosaku, Kuinose Masahiko, Tsushima Yoshimasa, Totsugawa Toshinori, Yoshitaka Hidenori, Chikazawa Genta
Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, 2-1-10 Marunouchi, Kita-ku, Okayama 700-0823, Japan.
Gen Thorac Cardiovasc Surg. 2011 Mar;59(3):195-8. doi: 10.1007/s11748-010-0657-0. Epub 2011 Mar 30.
A 79-year-old woman with Bland-White-Garland syndrome was admitted to our institution for surgical treatment of severe mitral regurgitation (MR). She had previously undergone mitral valve repair and coronary artery bypass grafting for both mitral insufficiency and a coronary artery anomaly 14 years earlier. However, the degree of residual MR had gradually worsened, and redo mitral valve surgery was scheduled. Multidetector row computed tomography revealed that the right coronary artery (RCA) was dilated and located just behind the sternum, and saphenous vein graft bypassed to the left anterior descending artery was occluded. This meant that the RCA was the only vessel supplying coronary blood flow. We successfully performed port-access mitral valve replacement under mild hypothermia with fibrillatory arrest to prevent damage to the RCA. We propose that port-access surgery is a safe and effective treatment for redo cardiac surgery after initial surgical correction of a congenital heart anomaly.
一名患有布兰德-怀特-加兰综合征的79岁女性因严重二尖瓣反流（MR）入我院接受手术治疗。14年前，她曾因二尖瓣关闭不全和冠状动脉异常接受过二尖瓣修复术和冠状动脉旁路移植术。然而，残余MR的程度逐渐加重，计划进行再次二尖瓣手术。多排螺旋计算机断层扫描显示右冠状动脉（RCA）扩张，位于胸骨后方，且旁路至左前降支的大隐静脉移植血管闭塞。这意味着RCA是唯一供应冠状动脉血流的血管。我们在轻度低温下采用颤动停止技术成功进行了端口入路二尖瓣置换术，以防止损伤RCA。我们认为，端口入路手术对于先天性心脏异常初次手术矫正后的再次心脏手术是一种安全有效的治疗方法。
