title: Mitral valve replacement in patients after aortic valve replacement.
abstract: BACKGROUND
  Mitral valve replacement in patients who previously had undergone aortic valve replacement is a technical challenge. The rigid aortic prosthesis limits visualization of the anterior mitral annulus and placement of sutures.
  
  
  METHODS
  Reoperative mitral valve replacement was performed in five patients after aortic valve replacement. Two patients underwent resternotomy to allow verification of normal aortic prosthetic valve function. Anterolateral right thoracotomy was used for reentry in the remaining three patients. Exposure of the anterior mitral annulus was accomplished by initial traction on the intact anterior leaflet, with resection of this leaflet only after placement of sutures.
  
  
  RESULTS
  All patients survived the surgical procedure and are well 2 to 30 months after operation. In one patient it was impossible to open one cusp of the mitral prosthesis, nor was it possible to rotate the valve. The valve was reimplanted, but sutures were tied only after testing for full free cusp motion.
  
  
  CONCLUSIONS
  When appropriate, right thoracotomy incision offers excellent exposure of the mitral valve with minimal dissection. Placement of sutures along the anterior portion of the annulus is facilitated by traction downwards on the anterior leaflet. Full range of motion of the prosthetic cusps should be verified before tying the sutures.
authors.affiliation: Department of Cardiothoracic Surgery, Hadassah University Hospital, Jerusalem, Israel. eamir@md2.huji.ac.il
authors.forename: A
authors.initials: A
authors.lastname: Elami
authors.forename: E
authors.initials: E
authors.lastname: Rudis
authors.forename: G
authors.initials: G
authors.lastname: Merin
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D012086:Reoperation; D013536:Suture Techniques