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食管重建术后感染性心内膜炎的二尖瓣修复:一例报告

Mitral valve repair for infective endocarditis after esophageal reconstruction: a case report.

作者信息

Tsushima Shingo, Iba Yutaka, Nakajima Tomohiro, Nakazawa Junji, Shibata Tsuyoshi, Ohkawa Akihito, Hosaka Itaru, Arihara Ayaka, Kawaharada Nobuyoshi

机构信息

Department of Cardiovascular Surgery, Sapporo Central Hospital, Minami-9, Nishi-10, Chuo-Ward, Sapporo-City, Hokkaido, 064-0809, Japan.

出版信息

Surg Case Rep. 2024 Feb 9;10(1):37. doi: 10.1186/s40792-024-01836-7.

Abstract

BACKGROUND

In patients with retrosternal neo-esophageal conduit after right thoracotomy, the approach to cardiac surgery could be challenging. Particularly, in patients with infective endocarditis, there is a risk of injury to the conduit through standard median sternotomy. Moreover, right lung adhesions could be predicted. Herein, we present a case of successful mitral valve repair in a patient with infective endocarditis through a redo right thoracotomy after esophageal reconstruction.

CASE PRESENTATION

A 66-year-old male patient was diagnosed with infective endocarditis and a large anterior mitral leaflet vegetation after a previous esophageal reconstruction via right thoracotomy for esophageal cancer. Due to the retrosternal esophageal reconstruction, we performed a mitral valve repair through a redo right thoracotomy. After resecting the vegetation, the defect was closed with a fresh autologous pericardial patch. Mitral valve annuloplasty was performed. Postoperatively, antibiotics controlled the infection. The patient was discharged on postoperative day 30.

CONCLUSIONS

Successful mitral valve repair was performed for infective endocarditis through a redo right thoracotomy after esophageal reconstruction.

摘要

背景

对于右胸开胸术后胸骨后新食管管道的患者,心脏手术的入路可能具有挑战性。特别是对于感染性心内膜炎患者,通过标准正中胸骨切开术有损伤管道的风险。此外,右肺粘连是可以预测的。在此,我们报告一例在食管重建术后通过再次右胸开胸对感染性心内膜炎患者成功进行二尖瓣修复的病例。

病例介绍

一名66岁男性患者,此前因食管癌经右胸开胸进行食管重建后,被诊断为感染性心内膜炎且二尖瓣前叶有一个大的赘生物。由于胸骨后食管重建,我们通过再次右胸开胸进行了二尖瓣修复。切除赘生物后,用新鲜自体心包补片封闭缺损。进行了二尖瓣环成形术。术后,抗生素控制了感染。患者于术后第30天出院。

结论

食管重建术后通过再次右胸开胸对感染性心内膜炎成功进行了二尖瓣修复。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d9f8/10853120/0a47c9e71416/40792_2024_1836_Fig1_HTML.jpg

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