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Surgical Management Of Severe Mitral Regurgitation In A Patient With Polycystic Kidney Disease And Anomalous Right Coronary Artery
Tamer M. Abdalghafoor, Sankar Balasubramanian, Lana Abu Afifeh;
Hamad Medical Corporation, Doha, Qatar
We present the case of a 53-year-old male patient with a medical history of hypertension and polycystic kidney disease associated with chronic kidney failure. The patient was referred to our hospital with symptomatic severe mitral regurgitation, presenting with shortness of breath, hemoptysis, and palpitation. Diagnostic assessments, including echocardiography and coronary angiogram, revealed the presence of severe mitral valve regurgitation due to flail P2 segment of the posterior mitral valve leaflet and an anomalous right coronary artery from p. Surgical intervention was performed, involving mitral valve repair and correction of the anomalous coronary artery. The patient’s recovery was uneventful, and follow-up assessments showed successful mitral valve repair.
Case Presentation: A 53-year-old male patient with a medical background of hypertension and polycystic kidney disease associated with chronic kidney failure presented to our hospital with symptomatic severe mitral regurgitation. The patient’s symptoms included dyspnea, hemoptysis, and palpitation. Physical examination revealed an irregular pulse and a blowing systolic murmur at the apex. ECG showed atrial fibrillation, and echocardiography confirmed the presence of severe mitral valve regurgitation due to flail P2 segment of the posterior mitral valve leaflet. Additionally, an anomalous right coronary artery was detected during a coronary angiogram.The patient underwent surgical intervention, which involved mitral valve repair and correction of the anomalous right coronary artery. The proximal part of the right coronary artery was mobilized and divided, and multiple accessory arterial and venous channels were ligated. The remaining hole in the pulmonary artery was repaired with a synthetic pericardial patch. Mitral valve repair was performed, including the placement of synthetic neo-chordae and plication of the small cleft between P2 and P3 segments. A semi-rigid annuloplasty ring was implanted, and the competency of the mitral valve was confirmed. The RCA button was reimplanted to the proximal aorta, ensuring it was not twisted or kinked.Postoperative Course: The patient’s recovery was unremarkable, and he did not require postoperative dialysis. He was discharged on the ninth postoperative day on anticoagulation for atrial fibrillation. At the one-month follow-up, the patient was doing well with no complaints. Echocardiographic assessment revealed successful mitral valve repair with trivial regurgitation.
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