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Panminerva Medica 1998 June;40(2):94-7

lingua: Inglese

Right thor­a­cot­o­my as an alter­na­tive for ­redo ­mitral ­valve replace­ment and con­com­i­tant ­repair of the tri­cus­pid ­valve

Terada Y., Mitsui T., Sakakibara Y., Tsutsui T., Okamura K., Jikuya T., Atsumi N., Shigeta O.

From the Depart­ment of Car­di­o­vas­cu­lar Sur­gery Insti­tute of Clin­i­cal Med­i­cine, Uni­ver­sity of Tsu­ku­ba, ­Tsukuba, Japan


Back­ground. We ­report ­the results of a ­right thor­a­cot­o­my for reop­er­a­tion on the ­mitral ­valve ­plus con­com­i­tant pro­ce­dures. ­Access to the aor­ta or to ­repair of oth­er ­lesions by ­this ­approach is con­tro­ver­sial.
Experi­men­tal ­design and set­ting. Ret­ro­spec­tive ­study. Insti­tu­tion­al prac­tice (Uni­ver­sity of Tsu­ku­ba Hos­pi­tal, Tsu­ku­ba, ­Japan).
Meth­ods. ­Until 1995, 9 ­patients under­went ­right thor­a­cot­o­my for ­mitral ­valve reop­er­a­tion. The indi­ca­tion for ­this ­approach was no ret­ro­ster­nal ­space ­with the per­i­car­di­um ­left ­open. Sev­en ­patients had dete­ri­orat­ed bio­pros­the­sis, 1 per­i­pros­thet­ic ­valve leak­age, and 1 re-sten­o­sis. ­Four ­were asso­ciat­ed ­with mod­er­ate tri­cus­pid regur­gi­ta­tion. Oper­a­tions ­were per­formed ­under fib­ril­la­tion. Car­di­o­ple­gia was ­used in 1.
­Results. ­Through thor­a­cot­o­my, 4 under­went ­mitral ­valve re-replace­ment, and 4 ­mitral ­valve re-replace­ment ­plus tri­cus­pid annu­lo­plas­ty. One was aban­doned ­because of ­severe pleu­ral adhe­sion. No neu­ro­log­i­cal inju­ry, or per­i­op­er­a­tive myo­car­dial infarc­tion ­occurred.
Con­clu­sions. The ­right thor­a­cot­o­my was an effec­tive alter­na­tive to ­repeat ster­not­o­my for ­redo ­mitral ­valve oper­a­tion. ­Also, con­com­i­tant ­repair of the tri­cus­pid ­valve ­could be safe­ly ­done by ­this ­approach.

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