Aortic Disruption At The Clamping Site In Mitral Valve Surgery Using Right Mini-thoracotomy
Asan Medical Center, Seoul, Korea, Republic of.
OBJECTIVE: In the minimally invasive cardiac surgery (MICS), transthoracic or trans-incisional aorta clamp is being used. The detachable trans-incisional clamp, Glauber clamp is useful because we can reduce the bleeding focus without the incision for aorta clamp. We report the case about the aorta injury caused by the x-shape aorta clamp.
METHODS: A 58-year-old male patient was admitted for mitral valve surgery. He was diagnosed with mitral stenosis and atrial fibrillation more than 10 years ago. He has been a state of left hemiparesis due to the embolic stroke since 6 years ago. Recently, he had aspiration pneumonia and tracheostomy was done for effective expectoration. After the treatment of pneumonia, he came to our institute for valve surgery.
RESULTS: He underwent mitral valve replacement with mechanical valve, modified Cox-Maze procedure using cryocatheter through the right mini-thoracotomy. The auricle of left atrium was closed with internal obliteration. Glauber clamp was used for aorta clamping. After the confirmation of mitral prosthesis with transesophageal echocardiography (TEE), we removed the root cannula and checked the ascending aorta for bleeding. However, his ascending aorta looked like to have false lumen, and we could confirm the type I aortic dissection with TEE. We made the median sternotomy and performed the ascending aorta replacement with 28mm graft under the moderate hypothermia. The aorta specimen shows the partial transection of aorta at the clamping site (figure). Postoperative course was uneventful and follow up echocardiography showed the well-functioning mitral prosthesis and atrial contraction.
CONCLUSIONS: The present case report the risk of aortic injury by the aorta clamping. In this x-shape clamp, the clamp pressure could not be even which can cause the aortic injury at the some part. To prevent the aortic injury by this clamp, we recommend the gentle clamping or if possible, the use of the soft protector.
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