Yano Atsushi, Ishido Kouhei, Katsube Toshio, Nagamine Yoshiyuki, Mikoshiba Haruki, Sumi Kohei, Ryogen Yun, Mukae Yousuke, Nakahara Yoshinori, Marui Akira, Iwakura Tomohiro
Department of Cardiovascular Surgery, Sakakibara Heart Institute, Fuchu, Japan.
Kyobu Geka. 2024 Sep;77(9):656-660.
We report a successful case of mitral valve replacement and coronary artery bypass grafting under mild hypothermia and systemic hyperkalemia in a patient with severely atheromatous ascending aorta on which placing a clamp seemed contraindicated. A 78-year-old man was referred to our hospital with the diagnosis of heart failure associated with severe mitral regurgitation and coronary artery disease. Echocardiography showed severe mitral regurgitation due to A3, P3 and posterior commissure (PC) prolapse and coronary angiography showed three vessel disease. Computed tomography( CT) revealed a severely atheromatous ascending aorta. Surgery was performed under cardiac arrest using systemic hyperkalemia and superior transseptal approach. Although cardiopulmonary bypass (CPB) time was a little prolonged in order to wash out potassium with dilutional ultrafiltration, the patient was uneventfully separated from CPB. The patient had no neurological complications and was discharged from the hospital 15 days after surgery. Mitral valve replacement under cardiac arrest using systemic hyperkalemia without cross clamping the aorta is useful to avoid neurological complications.
我们报告了一例成功的二尖瓣置换术及冠状动脉旁路移植术，该手术在轻度低温和全身性高钾血症状态下进行，患者升主动脉严重动脉粥样硬化，似乎禁忌放置主动脉夹。一名78岁男性因诊断为与严重二尖瓣反流和冠状动脉疾病相关的心力衰竭而转诊至我院。超声心动图显示因A3、P3和后联合（PC）脱垂导致严重二尖瓣反流，冠状动脉造影显示三支血管病变。计算机断层扫描（CT）显示升主动脉严重动脉粥样硬化。手术在心脏停搏下采用全身性高钾血症及经房间隔上入路进行。尽管为了通过稀释超滤清除钾，体外循环（CPB）时间稍有延长，但患者顺利脱离CPB。患者无神经并发症，术后15天出院。在心脏停搏下使用全身性高钾血症且不交叉夹闭主动脉进行二尖瓣置换术，有助于避免神经并发症。
