International Society For Minimally Invasive Cardiothoracic Surgery

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Explantation And Reimplantation Of A Mammoplasty Necessary For Minimally Invasive Mitral Valve Surgery In A Patient With Breast Cancer
Ayse Cetinkaya1, Stefan Hein1, Peter Bramlage2, Manfred Richter1, Markus Schönburg1.
1Department of Cardiac Surgery, Kerckhoff-Heart Center, Bad Nauheim, Germany, 2Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany.

We report on a 78 year old lady with a history of left and right sided breast cancer being previously provided with mammoplasty. She was admitted to our cardiac surgery department with dyspnea (NYHA III), third degree mitral valve regurgitation and atrial fibrillation (AF) mandating a surgical correction. The approach was right sided mini thoracotomy in the fifth intercostal space which proved to be impossible without injuring the mammoplasty. For this reason we decided to remove the mammoplasty performing a 7 cm skin incision under the right breast in order to prepare and open carefully the dense capsule of the mammoplasty. The explanted mammoplasty was inspected for integrity and preserved during minimally invasive mitral valve surgery (MIMVS) in an aseptic solution. This allowed us to prepare and open the fifth intercostal space, add a camera incision in the third intercostal space and a small incision for the atrial retractor. After total bypass, we opened the right atrium and interatrial septum. Left atrial retraction led to an excellent exposure of the mitral valve. Degenerative mitral valve disease with a retraction of the anterior and posterior leaflets required a replacement of the mitral valve with a 31 mm biological valve. After ablation therapy we closed the interatrial septum and released the aortic crossclamping. Adequate reperfusion was observed. TEE demonstrated a fully functional and competent mitral valve. The mammoplasty was then re-introduced without injuring the mammoplasty followed by typical wound closure of both the inframammary incision and the right mini thoracotomy. The patient recovered quickly without wound infection; the good condition was confirmed during a clinical visit after 18 month.


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