A Case of Redo Aortic Valve Replacement by Right Minithoracotomy Approach with Port Access for Aortic Valve Stenosis after Coronary Artery Bypass Grafting / 日本心臓血管外科学会雑誌

We report a case of redo aortic valve replacement by right minithoracotomy approach for aortic stenosis after coronary artery bypass grafting (CABG). An 81-year-old man was followed-up once a year for 9 years after CABG. He complained of increasing respiratory distress, showed narrowing of the aortic valve area, elevation of the aortic valve pressure gradient, and tricuspid valve regurgitation by echocardiography. He was admitted for surgery. We considered minimally invasive operation would be better for him and performed aortic valve replacement (Carpentier-Edwards Perimaunt valve 19 mm) by a right minithoracotomy approach because graft injury could occur by median sternotomy after CABG, and he had the risks of advanced age, low activities of daily living, and mild dementia. His postoperative course was uneventful. On echocardiography performed at postoperative days 9, the ejection fraction recovered to 75% from 53% before surgery and the mean aortic valve pressure gradient was 8 mmHg. He was discharged on postoperative day 12. Right minithoracotomy approach with port access is a good option for redo operation for aortic valve stenosis after CABG.

Penetrating Aortic Root Injury / 日本心臓血管外科学会雑誌

The patient was a 25-year-old man, who had been stabbed with a weapon siarilar to long ice pick. Thirty minutes later, he was admitted to our emergency center by ambulance. Anchocardiogram on admission revealed moderate pericardial effusion with normal heart function. Contrast medium enhanced computed tomography revealed that the weapon had entered from the left anterolateral chest wall and reached the posterior wall of the aortic root, approximately 1 cm above the left coronary artery orifice, through the left lung. During examinations, he suddenly went into shock and emergency open pericardial drainage was performed immediately. Approximately 400 ml of blood with a clot was removed from the pericardial cavity. After this procedure, there was no continuous bleeding. Subsequently, pseudoaneurysm developed at the aortic root injury site. Twenty seven days later, aortic surgery was performed. The injury site was resected and sutured directly, employing 4-0 polypropylene sutures with felt pledgets. He was discharged 14 days after the operation without any complications.