Simultaneous Mitral And Triduspid Valve Plasty And Maze Procedure Through A Lower T Shaped Sternotomy
ICHIRO HAYASHI1, Ichiro Kashima2, Hitoshi Nakanowatari2, Mitushiko Konno2.
1SELF DEFENCE FORCES CENTRAL HOSPITAL, TOKYO, Japan, 2SAITAMA EAST CIRCULATION HOSPITAL, TOKYO, Japan.
OBJECTIVE: Good results of mitral valve procedure (MVP) under right mini thoracotomy or inverted J shaped lower partial sternotomy have been reported. On the other hand under these incisions, coronary anastomosis, left internal thoracic artery (LITA) harvesting, left pulmonary vein isolation, left atrial appendage excision and tricuspid annuloplasty is challenging. In recent years, due to increasing cases gained with an advanced disease, also complex surgery cases concomitant with MVP have been increasing. Objective of this report is to present a successful case for treating MVP and some concomitant surgical procedure through a lower T shape sternotomy (LTSS).
METHODS: There is a case of mitral and tricuspid valve regurgitation, chronic atrial fibrillation due to both anterior and posterior leaflet of mitral valve prolapse, in preoperative coronary angiography diffuse stenosis in left anterior descending artery (LAD) was revealed. LITA harvesting, anterior mitral leaflet artificial chordae implantation and posterior leaflet triangular resection, tricuspid valve segmental annuloplasty, LITA-LAD anastomosis and maze procedure was performed under LTSS. To prevent postoperative false joint of sternum, mesh-type absorbable bone plate is available for reinforcement of vertically spitted sternum.
RESULTS: This patient had no serious adverse events.
CONCLUSIONS: LTSS was available for the cases who need concomitant procedure with MVP including left pulmonary vein isolation, LITA harvesting and coronary anastomosis. Although the risk of mediastinitis is a fault of sternotomy, LTSS showed almost the same operative field of view with a median full sternotomy incision, was useful option as a small incision surgery.
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