A Case Report of Mitral Valve Replacement for the Patient with Severely Calcified Mitral Annulus after Long-Term Hemodialysis / 日本心臓血管外科学会雑誌

A 53-year-old woman underwent mitral valve replacement for congestive heart failure due to mitral stenosis and regurgitation. She had been receiving hemodialysis because of diabetic nephropathy since 1993, and had had congestive heart failure since 1999. Echocardiography demonstrated mitral stenosis (MVA; 1.10cm²) and regurgitation with a severely calcified mitral annulus. Annular calcification extended to the posterior wall of the left ventricle and the base of bilateral papillary muscles. After removing all calcium from the mitral annulus to the base of the papillary muscle, the left ventricular posterior wall and mitral annulus were reconstructed by glutaraldehyde-preserved autologous pericardium. Then, a Carbo-Medics mechanical valve was placed at the mitral annulus using everting mattress sutures. Although her hemodynamics were stable, bacteremia and multi-organ failure developed 3 months after surgery and she died. Autopsy showed that the reconstructed left ventricular posterior wall and mitral annulus using glutaraldehyde preserved autologous pericardium were in excellent condition without any thrombus. No dehiscence was found at the suture line of the mechanical valve. Mitral annulus reconstruction with glutaraldehyde preserved autologous pericardium is thought to be effective for patients with calcified mitral annulus who require mitral valve surgery.

Continuous Hemofiltration in the Perioperative Management for Chronic Hemodialysis Patients Undergoing Coronary Artery Bypass Surgery / 日本心臓血管外科学会雑誌

Coronary artery bypass surgery was performed in 7 chronic hemodialysis patients. Hemodialysis and extracorporeal ultrafiltration methods were used during cardiopulmonary bypass, and continuous hemofiltration was performed in the early postoperative days in the intensive care unit. Water and electrolyte balances were successfully controlled in all patients, and hemodialysis was restarted after the second postoperative day. There were no perioperative complications and all patients are surviving. These methods of perioperative management for chronic hemodialysis patients undergoing coronary artery bypass surgery, especially consinuous hemofiltration in the early postoperative days, are considered safe and useful.