title: 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.
abstract: A 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.
authors.affiliation: Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Taguchi
authors.affiliation: Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia.
authors.forename: Jeswant
authors.initials: J
authors.lastname: Dillon
authors.affiliation: Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia.
authors.forename: Mohd Azhari
authors.initials: MA
authors.lastname: Yakub
mesh_terms: D001026:Coronary Artery Bypass / Q000009:adverse effects; D020878:Device Removal / Q000379:methods; D004696:Endocarditis / Q000209:etiology* / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000601:surgery*; D009181:Mycoses / Q000209:etiology / Q000601:surgery; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome