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An 84 Age - year Age - old Age male Sex patient with a history of coronary History artery History disease History and History right History coronary History artery History (RCA) History stenting History was admitted Clinical_event to our university Nonbiological_location hospital Nonbiological_location in February Date 2012 Date because of progressive Detailed_description dyspnoea Sign_symptom and recurring Detailed_description syncopes Sign_symptom .
Cardiological Diagnostic_procedure work Diagnostic_procedure - up Diagnostic_procedure revealed a grade Lab_value III Lab_value severe Severity symptomatic Detailed_description aortic Disease_disorder stenosis Disease_disorder .
Due to relevant comorbidities ( logistic Diagnostic_procedure EuroSCORE Diagnostic_procedure of 19 Lab_value points Lab_value ) and severe Severity femoral Biological_structure arteriopathy Disease_disorder , he was scheduled for trans Detailed_description - subclavian Detailed_description TAVI Therapeutic_procedure .
After successful implantation Coreference of a CoreValve Detailed_description prosthesis Detailed_description ( Medtronic Detailed_description ) [ Medtronic Detailed_description World Detailed_description Headquarters Detailed_description Medtronic Detailed_description Parkway Detailed_description Minneapolis, Detailed_description Minnesota, Detailed_description USA Detailed_description ] ( diameter Detailed_description 31 Detailed_description mm Detailed_description ) and initial discharge Clinical_event , he was referred Clinical_event back to the hospital Biological_structure because of dyspnoea Sign_symptom due to bilateral Detailed_description pleural Disease_disorder effusions Disease_disorder .
Transoesophageal Diagnostic_procedure echocardiography Diagnostic_procedure ( TEE Diagnostic_procedure ) showed a severe Severity mitral Sign_symptom regurgitation Sign_symptom ( MR Sign_symptom ), which was subsequently treated by interventional Detailed_description mitral Therapeutic_procedure valve Therapeutic_procedure repair Therapeutic_procedure using the MitraClip Biological_structure ( Abbott Detailed_description Vascular, Detailed_description Abbott Detailed_description Laboratories, Detailed_description Abbott Detailed_description Park, Detailed_description Illinois, Detailed_description U.S.A. Detailed_description ) and procedurally dependent atrial Therapeutic_procedure septal Therapeutic_procedure defect Therapeutic_procedure (ASD) Therapeutic_procedure closure Therapeutic_procedure AMPLATZER™ Detailed_description PFO Detailed_description Occluder Detailed_description (St.
Jude Medical GmbH, Helfmann-Park 7, Eschborn, Germany).
Two Date weeks Date after Date secondary Detailed_description discharge Clinical_event , the patient developed progressive Detailed_description heart Disease_disorder failure Disease_disorder in combination with acute Detailed_description renal Disease_disorder failure Disease_disorder .
Immediate Detailed_description echocardiography Diagnostic_procedure revealed a moderate Severity - to Severity - severe Severity aortic Sign_symptom regurgitation Sign_symptom and recurrent Detailed_description severe Severity MR Sign_symptom .
Valvular Sign_symptom defects Sign_symptom resulted from a slight Severity but Severity significant Severity aortic Sign_symptom valve Sign_symptom prosthesis Sign_symptom migration Sign_symptom towards the left Biological_structure ventricular Biological_structure outflow Biological_structure tract Biological_structure , which had caused aortic Sign_symptom paravalvular Sign_symptom leakage Sign_symptom and partial Detailed_description posterior Detailed_description mitral Sign_symptom leaflet Sign_symptom detachment Sign_symptom (Fig.1).
As a consequence of these findings, the patient was transferred Clinical_event to our cardiac Nonbiological_location surgery Nonbiological_location department Nonbiological_location .
Preoperative coronary Biological_structure angiography Diagnostic_procedure revealed a progression of the coronary Disease_disorder artery Disease_disorder disease Disease_disorder .
Consequently the patient was scheduled for conventional Detailed_description aortic Biological_structure and mitral Biological_structure valve Therapeutic_procedure replacement Therapeutic_procedure , as well as coronary Therapeutic_procedure artery Therapeutic_procedure bypass Therapeutic_procedure surgery Therapeutic_procedure .
The operation was performed via median Therapeutic_procedure sternotomy Therapeutic_procedure .
On initialization of cardiopulmonary Therapeutic_procedure bypass Therapeutic_procedure , the ascending Biological_structure aorta Biological_structure was opened Therapeutic_procedure for exploration Detailed_description of Detailed_description the Detailed_description aortic Detailed_description valve Detailed_description (Fig.2A).
After careful removal Therapeutic_procedure of the CoreValve Detailed_description prosthesis Detailed_description , an Edwards Detailed_description Perimount Detailed_description aortic Detailed_description valve Detailed_description prosthesis Detailed_description ( diameter Detailed_description 25 Detailed_description mm Detailed_description ) was implanted Therapeutic_procedure .
After vein Therapeutic_procedure - grafting Therapeutic_procedure of the circumflex Biological_structure coronary Biological_structure artery Biological_structure , the mitral Biological_structure valve Biological_structure was explored Detailed_description via Detailed_description the Detailed_description left Detailed_description atrium Detailed_description and excised Therapeutic_procedure with the attached Detailed_description clip Detailed_description .
Thereafter, an Edwards Detailed_description Perimount Detailed_description mitral Detailed_description valve Detailed_description prosthesis Detailed_description ( diameter Detailed_description 31 Detailed_description mm Detailed_description ) was implanted Therapeutic_procedure .
More recently, the atrial Therapeutic_procedure septal Therapeutic_procedure occluder Therapeutic_procedure was Therapeutic_procedure removed Therapeutic_procedure prior to direct closure Therapeutic_procedure of the resulting septal Sign_symptom defect Sign_symptom with a single Detailed_description - suture Detailed_description line Detailed_description (Fig.2B).
Intraoperative Detailed_description echocardiography Diagnostic_procedure revealed adequate Lab_value function Lab_value of Lab_value both Lab_value prostheses Lab_value and the operation was completed in the usual manner.
During the postoperative phase, the patient recovered Sign_symptom well Lab_value from surgery although hospitalization Clinical_event was Clinical_event prolonged Clinical_event by transient Detailed_description renal Disease_disorder failure Disease_disorder and recurring Detailed_description pleural Disease_disorder effusions Disease_disorder .
After Date a Date month Date of postoperative Therapeutic_procedure care Therapeutic_procedure , the patient was discharged Clinical_event from hospital Nonbiological_location to rehabilitation Therapeutic_procedure in a good Lab_value condition Diagnostic_procedure , without signs Sign_symptom for Sign_symptom heart Sign_symptom failure Sign_symptom .
At follow Clinical_event - up Clinical_event three Date months Date after Date surgery, the patient was still in a cardiopulmonary Lab_value stable Lab_value condition Diagnostic_procedure , undergoing additional physiotherapy Therapeutic_procedure .