Abstract
A 63-year-old woman underwent coronary artery bypass grafting and mitral annuloplasty 4 years previously. She was readmitted owing to heart failure. Cardiac catheterization revealed worsened mitral regurgitation, although the internal thoracic artery (ITA) graft had good patency. Reoperation was performed by median resternotomy and continuous retrograde cardioplegia without clamping the ITA graft. The mitral valve had a perforation in the anterior leaflet, and was replaced by a 29mm Carbo-Medicus valve. The patient was discharged with transient myocardial ischemia. Although median resternotomy and continuous retrograde cardioplegia at reoperation provided on excellent view and myocardial protection, myocardial ischemia in the region perfused by the ITA graft may occur when the ITA graft cannot be clamped during continuous retrograde cardioplegia.
