Mitral Valve Replacement via Anterolateral Right Thoracotomy without Cross-Clamping in a Patient with Fungal Infective Endocarditis and Functioning Internal Mammary Artery after Previous Coronary Artery Bypass Grafting and Mitral Valve Repair
AbstractA 55-year-old man developed severe mitral regurgitation with persistent fungal infective endocarditis 8 months after coronary artery bypass grafting with a left internal mammary artery and 2 saphenous veins, as well as mitral valve repair with a prosthetic ring. Echocardiography demonstrated severe mitral regurgitation and a valvular vegetation. Computed tomography coronary arteriography indicated that all grafts were patent and located intimately close to the sternum. Median resternotomy was not attempted due to the risk of injury to the bypass grafts, and therefore, a right anterolateral thoracotomy approach was utilized. Mitral valve replacement was performed with the patient under deep hypothermia and ventricular fibrillation without aortic cross-clamping. The patient`s postoperative course was uneventful. Thus, right anterolateral thoracotomy may be a superior approach to mitral valve surgery in patients who have undergone prior coronary artery bypass grafting.
Barbut D, Yao FS, Hager DN, Kavanaugh P, Trifiletti RR, Gold JP. 1996. Comparison of transcranial Doppler ultrasonography and transesophageal echocardiography to monitor emboli during coronary artery bypass surgery. Stroke 27:87-90.
Braxton JH, Higgins RS, Schwann TA, et al. 1996. Reoperative mitral valve surgery via right thoracotomy: decreased blood loss and improved hemodynamics. J Heart Valve Dis 5:169-73.
Byrne JG, Aranki SF, Adams DH, Rizzo RJ, Cooper GS, Cohn LH. 1999. Mitral valve surgery after previous CABG with functioning IMA grafts. Ann Thorac Surg 68:2243-7.
Byrne JG, Karavas AN, Adams DH, et al. 2001. The preferred approach for mitral valve surgery after CABG: right thoracotomy, hypothermia and avoidance of LIMA-LAD graft. J Heart Valve Dis 10:584-90.
Dexter F, Hindman BJ, Marshall JS. 1994. Estimate of the maximum absorption rate of microscopic arterial air emboli after entry into the arterial circulation during cardiac surgery. Perfusion 11:445-50.
Gillonov AM, Casselman FP, Lytle BW, et al. 1999. Injury to a patent left internal thoracic artery graft at coronary reoperation. Ann Thorac Surg 67:382-6.
Holman WL, Goldberg SP, Early LJ, et al. 2000. Right thoracotomy for mitral reoperation: analysis of technique and outcome. Ann Thorac Surg 70:1970-3.
Katircioglu SF, Cicekcioglu F, Tutun U, Parlar AI, Babaroglu S, Mungan U. 2008. On-pump beating heart mitral valve surgery without cross-clamping the aorta. J Card Surg 23:307-11.
Kitamura T, Stuklis RG, Edwards J. 2011. Redo mitral valve operation via right minithoracotomy-‘‘no touch’’ technique. Int Heart J 52:107-9.
Stemle CN, Bolling SF. 1996. Outcome of reoperative valve surgery via right thoracotomy. Circulation 94(suppl 9):II126-8.
Sylivris S, Levi C, Matalanis G, et al. 1998. Pattern and significance of cerebral microemboli during coronary artery bypass grafting. Ann Thorac Surg 66:1674-8.
Thompson MJ, Behranwala A, Campanella C, Walker WS, Cameron EWJ. 2003. Immediate and long-term results of mitral prosthetic replacement using a right thoracotomy beating heart technique. Eur J Cardiothorac Surg 24:47-51.
Tribble CG, Killinger WA Jr, Harman PK, Crosby IK, Nolan SP, Kron IL. 1987. Anterolateral thoracotomy as an alternative to repeat median sternotomy for replacement of the mitral valve. Ann Thorac Surg 43:380-2.
Umakanthan R, Leacche M, Petracek MR, et al. 2008. Safety of minimally invasive mitral valve surgery without aortic cross-clamp. Ann Thorac Surg 85:1544-50.
Yoda M, Minami K, Fritzsche D, Bairaktaris A, Koerfer R. 2005. Anterolateral right thoracotomy for mitral valve procedure after previous coronary artery bypass grafting with functioning internal mammary artery grafts. J Cardiovasc Surg (Torino) 46:51-4.