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Difficult Cross-clamping Of The Aorta In A Patient Who Underwent 3rd Time Redo Mitral Valve Replacement Via Right Mini-thoracotomy
Hiroyuki Nishi, Mutsunoti Kitahara, Yukie Shirasaki, Masao Yoshitatsu;
National Hospital Organization, Osaka National Hospital, Osaka, Japan
BACKGROUND In redo surgery for the mitral valve position, avoiding tissue damage during sternal re-entry is important. Also, obtaining a good view of the mitral valve becomes a problem. Right mini-thoracotomy approach (MICS approach) has a potential to solve those problems. Herein, we present a case in which 3rd time redo mitral valve replacement (MVR) was performed using MICS approach where cross-clamping of the aorta was difficult due to severe lung adhesion.
METHODS and RESULTS: A 69-year-old man with a history of two MVR surgeries suffered from severe perivalvular leakage, and a repeat surgery was required. Preoperative CT showed severe adhesions of the lungs under the sternum, and the decision was made to perform surgery using the MICS approach. A right mini-thoracotomy was performed through the fourth intercostal space. Although the lateral adhesion of the right lung was mild, the mediastinal side adhesion was very severe. We carefully proceeded with the dissection and was able to dissect the adhesions from the heart, but it was impossible to dissect the adhesions around the aorta because it was difficult to obtain a good surgical view. due to the angle. A safe additional median sternotomy was possible by dissecting the adhesions between the sternum and the lungs, and the area around the aorta was dissected from the midline to cross-clamp the aorta, and the mitral valve procedure was performed using the MICS approach with the left atrial retractor and a 3D endoscope.
CONCLUSIONS: When using the MICS approach in cases of redo mitral valve surgery, it may be difficult to dissect adhesions between the lungs and the aorta. As long as the adhesions between the sternum and the lung is dissected, median sternotomy can be made safely,, and a good view of the mitral valve can be secured with the MICS approach. This combination approach is one of the useful ways as a bailout method.
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