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[A case of aortic valve replacement 3 years after coronary artery bypass grafting]
I Shibasaki1, Y Sugita, Y Okamura
1Department of Thoracic Surgery, Dokkyo School of Medicine, Tochigi, Japan.
Insights
This case report details aortic valve replacement in a patient with poor left ventricular function after coronary artery bypass grafting. Successful AVR improved ejection fraction, demonstrating a viable treatment option for complex cardiac conditions.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- A 57-year-old male with prior coronary artery bypass grafting (CABG) presented with worsening aortic regurgitation (AR) and diminished left ventricular function.
- The patient had undergone urgent CABG 3 years prior, with initial AR noted as grade 2.
Observation:
- One year post-CABG, the patient experienced acute myocardial infarction due to saphenous vein graft occlusion, treated successfully with percutaneous transluminal angioplasty.
- Following graft intervention, progressive AR and declining left ventricular ejection fraction (LVEF) were observed, leading to congestive heart failure.
- Cardiac catheterization revealed grade 3 AR and a severely reduced LVEF of 17%.
Findings:
- Aortic valve replacement (AVR) was successfully performed via median sternotomy, preserving existing saphenous vein grafts.
- Postoperative recovery was uneventful, with significant improvement in LVEF to 40%.
Implications:
- This case highlights the feasibility and positive outcomes of AVR in patients with severely impaired left ventricular function following CABG.
- Preservation of native coronary artery bypass grafts during AVR is achievable and contributes to favorable patient recovery.
- Timely intervention with AVR can effectively manage advanced aortic regurgitation and improve cardiac function in high-risk surgical patients.
Abstract:
A rare case of aortic valve replacement (AVR) with poor left ventricular function, following coronary artery bypass grafting, was reported. The patient was 57-year-old man who received urgent CABG with 2 saphenous vein grafts 3 years ago. At that time, aortic regurgitation (AR) was grade 2. He suffered acute myocardial infarction 1 year after CABG because of the occlusion the saphenous vein graft to the obtuse marginal branch. Percutaneous transluminal angioplasty was successfully performed for occluded graft. Since then, however, AR increased gradually and the left ventricular function decreased. Three years after the initial operation, he was admitted again with congestive heart failure. Heart catheterization revealed grade 3 AR and 17% left ventricular ejection faction (LVEF). AVR was performed through a median sternotomy and 2 saphenous vein grafts were preserved. He showed uneventful postoperative recovery and is now very well with 40% LVEF.