2023 Volume 52 Issue 4 Pages 229-234
A 79-year-old man with severe aortic stenosis was referred to our department for surgical treatment. For the surgery, aortic valve replacement was performed with a bioprothetic valve (INSPIRIS RESILIA 23 mm, Edwards Lifesciences) at the supra annular position and proceeded without any particular problem till declamping. But weaning from cardiopulmonary bypass became difficult, and transesophageal ultrasonography showed the appearance of mitral valve systolic anterior motion (SAM), severe MR and LVOT. We tried to use with medical treatment (betablocker medications, cathecholamine intravenous injection and fluid administration), but the hemodynamics were unstable, so we decided to surgically treat the mitral valve with a second pump. We performed the Alfieri Stitch (edge to edge) for mitral valve systolic anterior motion (SAM) and severe MR, with no leakage detected in the leak test. Transesophageal ultrasonography revealed mild MR and the disappearance of SAM and LVOTO. The weaning from cardiopulmonary bypass was easy, and the operation was completed. Postoperative hemodynamics were good. Two weeks after the operation, transthoracic ultrasonography showed no problem. The patient was discharged 20 days after the operation. After discharge, the patient is doing well without recurrence of mitral valve SAM or worsening of MR.
