RESUMEN
We report a rare case of combined valvular disease concomitant with the communication between the coronary and bronchial arteries. A 76-year-old woman was given a diagnosis of chronic heart failure 8 years previously and received medical therapy but recently she had dyspnea. Ultrasound cardiography revealed aortic regurgitation and mitral regurgitation. Cardiac catheterization confirmed the combined valvular disease and also revealed an aberrant coronary artery. Cardiac computed tomography showed coronary to bronchial artery communication, which caused myocardial ischemia. We performed aortic valve replacement with a bioprosthesis, mitral valve repair, and ligation and division of the aberrant coronary artery. Apart from some postoperative bronchial bleeding that ceased spontaneously the postoperative course was uneventful.
RESUMEN
Ebstein's anomaly is a rare congenital heart disease. A 51-year-old man was hospitalized due to Ebstein's anomaly with severe congestive heart failure. He underwent Hetzer's procedure for tricuspid valve incompetence and right atrial isolation technique to restore the sinus rhythm. The postoperative course was uneventful, he was discharged from the hospital on the 21st day after the operation. The cardiothoracic ratio reduced from 74% before the operation to 60%. And his New York Heart Association functional class also improved from III to I after discharge. Hetzer's procedure for tricuspid valve repair in Ebstein's anomaly restructures the valve mechanism at the level of the true tricuspid annulus by using the most mobile leaflet for valve closure without placation of the atrialized chamber. We thus conclude that Hetzer's procedure, with anatomical evaluation of the malformed tricuspid valves before or during the operation, is beneficial as a simple and reproducible method for the repair of certain cases of Ebstein's anomaly.