[Aortic valve replacement through right thoracotomy; report of a case]

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Medical Imaging

Background:

• Severe aortic valve regurgitation (AVR) can present with complex anatomical challenges.
• A 78-year-old female patient experienced dyspnea and syncope due to severe aortic valve regurgitation.
• Pre-existing respiratory compromise and a history of pneumonia complicated the patient's condition.

Observation:

• Chest X-ray and computed tomography (CT) revealed significant mediastinal shift to the right.
• Key cardiovascular structures, including the main pulmonary artery, right atrium (RA), and right pulmonary veins, were displaced.
• The patient presented with severe constrictive respiratory function.

Findings:

• Right thoracotomy at the 4th intercostal space provided an adequate surgical field.
• Successful aortic valve replacement was achieved using cardiopulmonary bypass.
• No intraoperative ventricular fibrillation occurred despite the challenging anatomy.

Implications:

• Right thoracotomy is a viable surgical approach for aortic valve replacement in patients with severe mediastinal shift.
• This case highlights the importance of detailed pre-operative imaging for surgical planning in complex cardiac cases.
• Minimally invasive cardiac surgery techniques may be adapted for patients with significant anatomical variations.