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Mitral valve replacement and MAZE procedure because of mitral valve stenosis and paroxysmal atrial fibrillation

Mitral valve replacement and MAZE procedure because of mitral valve stenosis and paroxysmal atrial fibrillation

The case report describes the hospitalization of a 63-year-old patient admitted to the Department of heart surgery for mitral valve stenosis with diagnosed atrial fibrillation. The patient underwent mitral valve replacement and MAZE procedure. At the postoperative period, paroxysm of atrial fibrillation was successfully detected with a successful version. On the tenth postoperative day, the patient was placed in outpatient care.


 

Anamnesis:

63-year-old woman
PA: paroxysmal ventricular fibrillation with fast ventricular response EHRA III, arterial hypertension 2st. ESH / ESC, high level of blood lipids, Sjögren's syndrome, no other diseases.
FA: mother died 76-years-old after stroke, father has overcome myocardial infarction (3x) and died after stroke, sister had stroke, two children with no diseases.
PA: Furosemid Forte 250 mg 1/2-0-0 tbl, Verospiron 25mg tbl. 1-1-1, Egilok 25mg tbl. 1-0-1, Cordarone 200mg tbl. 1-0-0 (So, Ne ex), Prenessa 4mg tbl. 1/2-0-0, Sorbifer. dur. tbl. 1-0-1, Milurit 300mg tbl. 1/2-0-0, Atoris 10mg 0-0-1 tbl, Fraxiparine 0,6 j s.c. á 12 hod
AA: Trypsin, Ketazon, Floristen, Acylpyrín , leukoplast
DA: ex-smoker, alcohol rarely
SA: pensioner, she lives alone in a family home
GA: menopause in 82-years old, 2 births
AD: Patient repeatedly hospitalized for cardiac decompensation (last one was 7 months and 1 month ago), one year ago she was already hospitalized with mitral valve stenosis diagnosis, she refused surgery a year ago. Now transferred to the cardiac surgery clinic after repeated cardiac decompensation in paroxysmal atrial fibrillation and postreumatic mitral stenosis.

Laboratoty results:

Laboratory results: in the standard.
Dental: no signs of focal infection.
ORL examination: no evidence of focal infection.

Imaging methods:

ECHO: aorta bulb 29mm, ascending aorta 28mm, aortic valve cusps: 3 fibrotic, Vmax: 1,9, LA: 50mm, mitral valve: front tip thickened, rear immobile, mitral ring calcified, MVA 1.06cm2, diastolic middle gradient: 11.0-14 mmHg, regurgitation moderate. LVEF 60%, mean tricuspid valve diameter: 3.6 cm.
Conclusion: undiluted left ventricle, kinetics is adequate, on mitral valve image serious to severe stenosis and severe regurgitation, calcification on mitral annulus, dilated LA, fibrotic changes in the aortic valve without significant flap error, pericardium without a pathological finding

ECG on receipt: SR fr. 60 / min, irregular rhythm, numerous SVES, el. axes 60 °, R / S V3, PQ 180ms, QRS 100ms, QT 520ms, ST isoelectric.

Coronarography: ACS: no stenosis, LAD: no stenosis, normal flow. RCX: no stenosis, ACD: no significant stenosis

USG of carotid arteries: Right side: ACC without stenosis, ACI stenosis about 65%, ACE without stenosis, Left side: ACC without stenosis, ACI has about 60% stenosis, ACE without stenosis.

Diagnoses:

Combined mitral error, MS moderate to severe, MR moderate (MVA 1.0cm2, EROA 0.3cm2)
Moderate post-capillary PH,
Paroxysmal AF EHRA II-III, SR presented
Arterial hypertension
Hyperlipidaemia
Struma parva

Therapy and conclusion:

Treatment strategy:
Patient is indicated for mitral valve replacement and MAZE surgery procedure because of mitral stenosis and AF.

Surgery procedure:
Substitutio valvulae mitralis cum prostesis mechanica Onyx No. 23, kryoMAZE, CPB time: 105min, aortic cross clamp: 83min.

Postoperative course:
Post-operative period complicated by transient renal failure. Dialysis needed during 2nd and 3rd postoperative day. Next period complicated by AF with tachycardia (duration 4hours). After continuous amiodaron application version on SR. On 10th postoperative day released to outpatient care.

 

Abbreviations:
ACC – arteria carotis communis; ACD – right coronary artery; ACE – arteria carotis externa; ACI – arteria carotis interna; ACS – left coronary artery; AF – atrial fibrillation; CPB – cardiopulmonary bypass; ECHO – echocardiography; EROA - effective regurgitant orifice area; IM – myocardial infarction; LA – left atrium; LAD – left anterior descending artery; LVEF – left ventricle ejection fraction; MAZE – surgery procedure for atrial fibrillation treatment; MR – mitral regurgitation; MS – mitral stenosis; MVA – mitral valve area; NCMP – stroke; ORL – otorhinolaryngology; RCX – ramus circumflexus; SR – sinus rhythm; SVES – atrial extra systole; USG – ultrasonography

Authors declare the case report will not be published in any national or international publications.

 

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Creative Commons LicenseContribution content is subject to licence Creative Commons Uveďte autora-Neužívejte dílo komerčně-Nezasahujte do díla Attribution 3.0 Czech Republic
author: Tomáš Toporcer | organization: Department of Heart Surgery | published on: 22.11.2017 | last modified on: 11.12.2017
citation: Toporcer Tomáš: Mitral valve replacement and MAZE procedure because of mitral valve stenosis and paroxysmal atrial fibrillation. Multimedia support in the education of clinical and health care disciplines :: Portal of Faculty of Medicine [online] 2017-11-22, last modif. 2017-12-11 [cit. 2018-01-17] Available from WWW: <http://portal.lf.upjs.sk/articles.php?aid=302>. ISSN 1337-7000.
 

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