title: Mitral valve replacement via right thoracotomy approach for prevention of mediastinitis in a female patient with long-term uncontrolled diabetes mellitus: a case report.
abstract: A 76-year-old woman with a history of percutaneous transvenous mitral commissurotomy and repeated hospital admissions due to heart failure was referred for an operation for severe mitral valve stenosis. She presented with hypertension, hyperlipidemia and cerebral infarction with stenosis of right internal carotid artery, retinopathy, neuropathy and nephropathy caused by long-term uncontrolled diabetes mellitus, hemoglobin A1c of 9.4%, and New York Heart Association (NYHA) functional classification of 3/4. Echocardiography revealed severe mitral valve stenosis with mitral valve area of 0.6 cm2, moderate tricuspid valve regurgitation, and dilatation of the left atrium. Taking into consideration the NYHA functional classification and severe mitral valve stenosis, an immediate surgical intervention designed to prevent mediastinitis was performed. The approach was via the right 4th thoracotomy, as conventional sternotomy would raise the risk of mediastinitis. Postoperative antibiotics were administered intravenously for 2 days, and signs of infection were not recognized.In patients with long-term uncontrolled diabetes mellitus, mid-line sternotomy can easily cause mediastinitis. The choice of operative approach plays an important role in preventing this complication. In this report, the importance of the conventional right thoracotomy for prevention for mediastinitis is reviewed.
authors.affiliation: Department of Cardiovascular surgery, Kobe City Medical Center General Hospital, 4-6 Minatojimanakamachi, Chuo-ku, Kobe, Hyogo 650-0046, Japan. naotowakimachi@hotmail.co.jp
authors.forename: Naoto
authors.initials: N
authors.lastname: Fukunaga
authors.forename: Takashi
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Ozu
authors.forename: Shigeru
authors.initials: S
authors.lastname: Komori
authors.forename: Yu
authors.initials: Y
authors.lastname: Shomura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Michihiro
authors.initials: M
authors.lastname: Nasu
authors.forename: Yukikatsu
authors.initials: Y
authors.lastname: Okada
mesh_terms: D000368:Aged; D048909:Diabetes Complications; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008480:Mediastinitis / Q000209:etiology / Q000517:prevention & control*; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000150:complications* / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control*; D013908:Thoracotomy