Shiraishi Manabu, Yamaguchi Atsushi, Adachi Hideo
Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan.
Ann Thorac Cardiovasc Surg. 2012;18(4):379-81. doi: 10.5761/atcs.cr.11.01767. Epub 2011 Dec 9.
We report a case of an apico-aortic bioprothesis-valved conduit for a 70-year-old-woman with symptomatic, severe aortic stenosis and severe calcification of the ascending aorta. She had a history of mastectomy and radiation therapy for breast cancer and was suffering from radiodermatitis and chronic thoracic wall infection. Transthoracic echocardiography showed severe aortic valve stenosis with heavy calcification and high aortic valve pressure gradients. In patients with a chronically infected thoracic wall, median sternotomy is considered to be a high risk procedure, resulting in postoperative mediastiniti; therefore, we applied a technique in which we used an apico-aortic conduit via posterolateral thoracotomy. We underwent apico-aortic bypass with a hand-made composite graft: 19-mm bioprosthetic valve and a 22-mm woven polyester vascular graft. The surgical intervention successfully decreased pressure gradient across the aortic valve, also separating an incision from chronic infection allowed us to avoid postoperative mediastinitis. The patient had remained in good condition for 15 months without developing any complications.
我们报告了一例为一名70岁女性采用心尖-主动脉生物瓣膜管道的病例，该女性患有有症状的严重主动脉瓣狭窄和升主动脉严重钙化。她有乳腺癌乳房切除术和放射治疗史，患有放射性皮炎和慢性胸壁感染。经胸超声心动图显示严重主动脉瓣狭窄伴重度钙化和高主动脉瓣压力阶差。对于胸壁长期感染的患者，正中开胸被认为是高风险手术，会导致术后纵隔炎；因此，我们采用了一种经后外侧开胸使用心尖-主动脉管道的技术。我们使用手工制作的复合移植物进行心尖-主动脉旁路手术：19毫米生物瓣膜和22毫米编织聚酯血管移植物。手术干预成功降低了主动脉瓣跨瓣压力阶差，并且将切口与慢性感染隔开使我们避免了术后纵隔炎。患者状况良好已持续15个月，未出现任何并发症。
