Mitral annular reconstruction with anterior leaflet flip-over in concomitant surgery for mitral regurgitation associated with extensive posterior annular calcification and hypertrophic obstructive cardiomyopathy

General Thoracic and Cardiovascular Surgery - Tập 52 - Trang 104-106 - 2004
Hiroshi Okamoto1, Akinori Tamenishi1, Yutaka Itoh1, Takao Niimi1
1Department of Thoracic and Cardiovascular Surgery, Yokkaichi City Hospital, Mie, Japan

Tóm tắt

We describe a case of severely calcified posterior mitral annulus associated with grade IV mitral re-gurgitation in addition to significant hypertrophic obstructive cardiomyopathy. A 70-year-old woman underwent successfully annular reconstruction with anterior mitral leaflet flip-over and mitral valve replacement with a bileaflet mechanical prosthesis combined with left ventricular septal myectomy. This technique can serve not only to cover the debrided posterior annulus, but also to eliminate left ventricular outflow tract obstruction and to keep left ventricular function by virtue of not severing ventricular-annular continuity.

Tài liệu tham khảo

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