Beating-heart left posterolateral thoracotomy for mitral valve replacement

Abstract

Introduction and objectives: The case concerns a 34-year-old man with Marfan syndrome and Pectus Excavatum that has been previously operated on for an ascending aortic aneurysm and aortic regurgitation using the David I technique in 2007. The patient currently has severe mitral regurgitation due to rupture of the anterior chordae leaflet. The objective is to demonstrate that left posterolateral thoracotomy is a feasible alternative in certain selected cases for the treatment of mitral valve pathology.Methods: Given the anatomical characteristics of the patient, and previous cardiac surgery, posed the question of what would be the best approach for this case. After a review of the literature and expert consultations, it was decided to perform a mitral valve replacement via left posterolateral thoracotomy. To do this, after left posterolateral thoracotomy and cannulation at the level of the descending thoracic aorta and left common femoral vein (Seldinger), extracorporeal circulation was started. Given the impossibility of aortic clamping, it was decided to perform beating heart mitral valve replacement in a CO2 environment. To do this, a left atriotomy was performed and, using various recovery aspirators, an acceptable view of the mitral valve was achieved. I was decided to replace it, due to the technical difficulties that a valve repair would entail.Results: The mitral replacement was successfully performed by transoesophageal echocardiography.Conclusions: Left posterolateral thoracotomy may be an alternative for patients with concomitant pathologies that cause displacement of the heart towards the left hemithorax. Published by Elsevier Espana, S.L.U. on behalf of Sociedad Espanola de Cirugia Cardiovascular y Endovascular.