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[Surgical treatment of chronic intestinal ischemia associated with combined valvular disease]
1Department of Cardiovascular Surgery, Sendai City Medical Center, Japan.
Insights
A 69-year-old male with heart failure and abdominal pain underwent successful treatment for combined valvular disease and superior mesenteric artery (SMA) stenosis. Surgical intervention relieved symptoms, improving his overall health.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Gastroenterology
Background:
- The patient presented with congestive heart failure and significant postprandial abdominal pain, leading to weight loss.
- Cardiac catheterization revealed combined severe mitral regurgitation (MR III) and tricuspid regurgitation (TR III).
- Visceral arteriography identified critical 75% stenosis at the origin of the superior mesenteric artery (SMA).
Observation:
- The SMA stenosis posed a significant vascular challenge, with the common hepatic artery originating beyond the narrowed segment.
- The patient's symptoms of postprandial abdominal pain and weight loss were attributed to mesenteric ischemia secondary to SMA stenosis.
- Combined valvular heart disease necessitated a staged surgical approach.
Findings:
- Successful SMA-abdominal aortic bypass grafting using an autologous saphenous vein graft was performed.
- Postoperative resolution of postprandial abdominal pain was observed following the vascular reconstruction.
- The patient subsequently underwent successful mitral valve replacement (MVR) with a Björk-Shiley mechanical valve and tricuspid annuloplasty (TAP) with a Carpentier-Edwards ring.
Implications:
- This case highlights the successful management of concurrent severe valvular heart disease and mesenteric ischemia.
- Surgical revascularization of the SMA can effectively alleviate ischemic abdominal pain, improving patient outcomes.
- A staged surgical approach addressing both vascular and cardiac issues is feasible and beneficial in complex cases.
Abstract:
A 69-year-old male was admitted with congestive heart failure and postprandial abdominal pain with weight loss. Combined valvular disease (MR III+TR III) was demonstrated by cardiac catheterization. Selective visceral arteriography revealed 75% stenosis at the origin of SMA and common hepatic artery arose beyond the stenosis. SMA-abdominal aortic bypass grafting using auto-saphenous vein graft was performed initially. Postprandial abdominal pain disappeared after bypass grafting, and then MVR with Björk-Shiley mechanical valve and TAP with Carpentier- Edwards ring was performed.