J Heart Valve Dis
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Mitral valve injury from blunt trauma to the chest is an uncommon entity. We report a case of mitral valve injury after a fall, and its repair. The English literature is reviewed from the earliest report in 1873 to the present. The diagnosis, types of injury and surgical correction are discussed.
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Transannular patch repair of tetralogy of Fallot leads to pulmonary insufficiency and progressive right ventricular dilatation responsible for a decreased exercise capacity. We studied the impact of late homograft insertion on the regression of the right ventricular volumes in symptomatic patients. ⋯ An increasing number of patients who had transannular patch repair for tetralogy of Fallot will require reoperation for symptomatic long-term pulmonary regurgitation. Homograft reconstruction of the right ventricular outflow tract of these patients induces regression of their right ventricular dilatation and leads to their functional recovery.
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Although both right anterolateral thoracotomy and median sternotomy have been used for mitral valve surgery (repair/replacement), the latter approach is considered standard for primary mitral valve surgery. We hypothesized that primary mitral valve surgery, if performed through a right anterolateral thoracotomy, would not only be better accepted cosmetically by patients, but also make redo surgery through a median sternotomy easy and trouble free from re-entry bleeding. ⋯ Right anterolateral thoracotomy provides excellent exposure of the mitral valve, even with a small left atrium, and offers a better cosmetic lateral scar which is less prone to keloid formation. In addition, right anterolateral thoracotomy is as safe as median sternotomy for primary mitral valve repair/replacement, and should be used as an initial approach to mitral valve surgery, while median sternotomy be kept for repeat mitral valve or other open-heart surgery required later in life.
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These studies were designed to assess the effect of low-dose anticoagulation in elderly patients after mitral valve replacement. ⋯ Low-dose oral anticoagulation after mitral valve replacement with St. Jude Medical prosthesis in elderly patients provided satisfactory clinical results.