Left thoracotomy for aortic and mitral valve surgery in a case of mediastinal displacement due to pneumonectomy.
A 68-year-old male patient with low cardiac output was referred for a redo aortic valve replacement (AVR). Four years earlier, he had undergone a left pneumonectomy for a bronchial carcinoma. Due to the severe shift of the mediastinum into the left chest, as well as to adhesions of the right lung to the sternum, a median sternotomy was thought undesirable. AVR was performed through a left anterior thoracotomy through the fourth intercostal space. The following day, the worsening of a pre-existing mitral insufficiency due to leaflet tethering was diagnosed. Mitral valve annuloplasty was then achieved via a left posterior thoracotomy through the sixth intercostal space. Three weeks later, the patient had recovered a normal hemodynamic and spontaneous breathing. A left thoracotomy should be considered as an alternative approach for valve surgery in case of severe heart displacement.
Département de Chirurgie Cardiovasculaire, Institut de Cardiologie, Hôpital Pitié Salpétrière, Paris, France.
Theodoro
T
Barreda
Mojgan
M
Laali
Richard
R
Dorent
Christophe
C
Acar
D001024:Aortic Valve Stenosis / Q000601:surgery*; D001984:Bronchial Neoplasms / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008482:Mediastinum / Q000473:pathology; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D011013:Pneumonectomy / Q000009:adverse effects*; D012086:Reoperation; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed