tailieunhanh - Báo cáo y học: " Mitral valve replacement via right thoracotomy approach for prevention of mediastinitis in a female patient with long-term uncontrolled diabetes mellitus: a case report"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Wertheim cung cấp cho các bạn kiến thức về ngành y đề tài: Mitral valve replacement via right thoracotomy approach for prevention of mediastinitis in a female patient with long-term uncontrolled diabetes mellitus: a case report. | Fukunaga et al. Journal of Cardiothoracic Surgery 2010 5 38 http content 5 1 38 JOURNAL OF CARDIOTHORACIC SURGERY CASE REPORT Open Access Mitral valve replacement via right thoracotomy approach for prevention of mediastinitis in a female patient with long-term uncontrolled diabetes mellitus a case report Naoto Fukunaga Takashi Hashimoto Yasuhisa Ozu Shigeru Komori Yu Shomura Hiroshi Fujiwara Michihiro Nasu and Yukikatsu Okada Abstract A 76-year-old woman with a history of percutaneous transvenous mitral commissurotomy and repeated hospital admissions due to heart failure was referred for an operation for severe mitral valve stenosis. She presented with hypertension hyperlipidemia and cerebral infarction with stenosis of right internal carotid artery retinopathy neuropathy and nephropathy caused by long-term uncontrolled diabetes mellitus hemoglobin A1c of and New York Heart Association NYHA functional classification of 3 4. Echocardiography revealed severe mitral valve stenosis with mitral valve area of cm2 moderate tricuspid valve regurgitation and dilatation of the left atrium. Taking into consideration the NYHA functional classification and severe mitral valve stenosis an immediate surgical intervention designed to prevent mediastinitis was performed. The approach was via the right 4th thoracotomy as conventional sternotomy would raise the risk of mediastinitis. Postoperative antibiotics were administered intravenously for 2 days and signs of infection were not recognized. In patients with long-term uncontrolled diabetes mellitus mid-line sternotomy can easily cause mediastinitis. The choice of operative approach plays an important role in preventing this complication. In this report the importance of the conventional right thoracotomy for prevention for mediastinitis is reviewed. Background In patients with long-term uncontrolled diabetes melli-tus mediastinitis is a critical complication of cardiovascular surgery and may .