Taguchi Takahiro, Dillon Jeswant, Yakub Mohd Azhari
Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Japan.
Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia.
Heart Surg Forum. 2016 Feb 24;19(1):E33-5. doi: 10.1532/hsf.1359.
A 55-year-old man developed severe mitral regurgitation with persistent fungal infective endocarditis 8 months after coronary artery bypass grafting with a left internal mammary artery and 2 saphenous veins, as well as mitral valve repair with a prosthetic ring. Echocardiography demonstrated severe mitral regurgitation and a valvular vegetation. Computed tomography coronary arteriography indicated that all grafts were patent and located intimately close to the sternum. Median resternotomy was not attempted due to the risk of injury to the bypass grafts, and therefore, a right anterolateral thoracotomy approach was utilized. Mitral valve replacement was performed with the patient under deep hypothermia and ventricular fibrillation without aortic cross-clamping. The patient`s postoperative course was uneventful. Thus, right anterolateral thoracotomy may be a superior approach to mitral valve surgery in patients who have undergone prior coronary artery bypass grafting.
一名55岁男性在接受冠状动脉搭桥术（使用左乳内动脉和两条大隐静脉）及二尖瓣人工瓣环修复术后8个月，出现严重二尖瓣反流并伴有持续性真菌性感染性心内膜炎。超声心动图显示严重二尖瓣反流和瓣膜赘生物。计算机断层扫描冠状动脉造影表明所有移植血管通畅且紧贴胸骨。由于有损伤移植血管的风险，未尝试正中胸骨切开术，因此采用右前外侧开胸入路。在患者深低温和室颤状态下未进行主动脉阻断的情况下实施二尖瓣置换术。患者术后恢复顺利。因此，对于既往接受过冠状动脉搭桥术的患者，右前外侧开胸入路可能是二尖瓣手术的一种较好的方法。
