High-risk Coronary Artery Bypass Grafting and Mitral Valve Replacement in a HIV Positive Patient
Certain subsets of high-risk mitral valve patients are not suitable candidates for transcatheter therapies. The objective of this report is to present a young patient with combined mitral valve and coronary artery disease to illustrate these challenges.In this report, we present a 47-year-old man wi...
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| Format: | Article |
| Language: | English |
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Mashhad University of Medical Sciences
2017-06-01
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| Series: | Journal of Cardio-Thoracic Medicine |
| Subjects: | |
| Online Access: | http://jctm.mums.ac.ir/article_8819_3d62560c341ab8919c8031a20aa4c1f2.pdf |
| _version_ | 1818272754712969216 |
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| author | Juan Siordia Sreekumar Subramanian |
| author_facet | Juan Siordia Sreekumar Subramanian |
| author_sort | Juan Siordia |
| collection | DOAJ |
| description | Certain subsets of high-risk mitral valve patients are not suitable candidates for transcatheter therapies. The objective of this report is to present a young patient with combined mitral valve and coronary artery disease to illustrate these challenges.In this report, we present a 47-year-old man with longstanding HIV infection who was referred with severe mitral regurgitation (MR) and profound cardiomyopathy to highlight the importance of decision-making and perioperative management.A 47-year-old HIV positive man with New York Heart Association class IV congestive heart failure was found to have severe MR (mixed Carpentier Type I and IIIB pathologies). The last viral load titer of the patient was undetectable. Cardiac catheterization revealed a chronic total occlusion of the middle of left anterior descending artery, ostial obtuse marginal and 70% posterior descending artery lesion, as well as severe pulmonary hypertension (PAP of 70/30 (mean: 43)), and a pulmonary vascular resistance of 4.6 Woods units. Preoperative cardiac magnetic resonance imaging showed left ventricular ejection fraction of 20%, right ventricular ejection fraction of 30%, nonviable circumflex distribution and scattered viability in the anterior and inferior cardiac walls. He underwent a high-risk coronary artery blood grafting plus mitral valve (MV) replacement (with intra-aortic balloon pump support). The postoperative course was complicated by gastrointestinal bleeding requiring transfusion, aspiration pneumonitis, atrial flutter and difficile colitis. However, the patient recovered appropriately, and remained asymptomatic and healthy in three months follow-up postoperatively. Application of transcatheter MV or device-assisted therapies for high-risk patients with severe MR might be limited due to financial, medical or social situations. In these instances, high-risk mitral valve surgery may still be the choice treatment in the selected patients. |
| first_indexed | 2024-12-12T21:47:06Z |
| format | Article |
| id | doaj.art-d22ef13ab85048b8ba3b6db09cec084e |
| institution | Directory Open Access Journal |
| issn | 2345-2447 2322-5750 |
| language | English |
| last_indexed | 2024-12-12T21:47:06Z |
| publishDate | 2017-06-01 |
| publisher | Mashhad University of Medical Sciences |
| record_format | Article |
| series | Journal of Cardio-Thoracic Medicine |
| spelling | doaj.art-d22ef13ab85048b8ba3b6db09cec084e2022-12-22T00:10:53ZengMashhad University of Medical SciencesJournal of Cardio-Thoracic Medicine2345-24472322-57502017-06-015258358610.22038/jctm.2017.13001.10828819High-risk Coronary Artery Bypass Grafting and Mitral Valve Replacement in a HIV Positive PatientJuan Siordia0Sreekumar Subramanian1Research Assistant, University of Arizona College of Medicine, Tucson, Arizona, United StatesSurgeon, University of Arizona College of Medicine, Tucson, Arizona, United StatesCertain subsets of high-risk mitral valve patients are not suitable candidates for transcatheter therapies. The objective of this report is to present a young patient with combined mitral valve and coronary artery disease to illustrate these challenges.In this report, we present a 47-year-old man with longstanding HIV infection who was referred with severe mitral regurgitation (MR) and profound cardiomyopathy to highlight the importance of decision-making and perioperative management.A 47-year-old HIV positive man with New York Heart Association class IV congestive heart failure was found to have severe MR (mixed Carpentier Type I and IIIB pathologies). The last viral load titer of the patient was undetectable. Cardiac catheterization revealed a chronic total occlusion of the middle of left anterior descending artery, ostial obtuse marginal and 70% posterior descending artery lesion, as well as severe pulmonary hypertension (PAP of 70/30 (mean: 43)), and a pulmonary vascular resistance of 4.6 Woods units. Preoperative cardiac magnetic resonance imaging showed left ventricular ejection fraction of 20%, right ventricular ejection fraction of 30%, nonviable circumflex distribution and scattered viability in the anterior and inferior cardiac walls. He underwent a high-risk coronary artery blood grafting plus mitral valve (MV) replacement (with intra-aortic balloon pump support). The postoperative course was complicated by gastrointestinal bleeding requiring transfusion, aspiration pneumonitis, atrial flutter and difficile colitis. However, the patient recovered appropriately, and remained asymptomatic and healthy in three months follow-up postoperatively. Application of transcatheter MV or device-assisted therapies for high-risk patients with severe MR might be limited due to financial, medical or social situations. In these instances, high-risk mitral valve surgery may still be the choice treatment in the selected patients.http://jctm.mums.ac.ir/article_8819_3d62560c341ab8919c8031a20aa4c1f2.pdfCoronary artery bypass graftingHIVMitral Valve |
| spellingShingle | Juan Siordia Sreekumar Subramanian High-risk Coronary Artery Bypass Grafting and Mitral Valve Replacement in a HIV Positive Patient Journal of Cardio-Thoracic Medicine Coronary artery bypass grafting HIV Mitral Valve |
| title | High-risk Coronary Artery Bypass Grafting and Mitral Valve Replacement in a HIV Positive Patient |
| title_full | High-risk Coronary Artery Bypass Grafting and Mitral Valve Replacement in a HIV Positive Patient |
| title_fullStr | High-risk Coronary Artery Bypass Grafting and Mitral Valve Replacement in a HIV Positive Patient |
| title_full_unstemmed | High-risk Coronary Artery Bypass Grafting and Mitral Valve Replacement in a HIV Positive Patient |
| title_short | High-risk Coronary Artery Bypass Grafting and Mitral Valve Replacement in a HIV Positive Patient |
| title_sort | high risk coronary artery bypass grafting and mitral valve replacement in a hiv positive patient |
| topic | Coronary artery bypass grafting HIV Mitral Valve |
| url | http://jctm.mums.ac.ir/article_8819_3d62560c341ab8919c8031a20aa4c1f2.pdf |
| work_keys_str_mv | AT juansiordia highriskcoronaryarterybypassgraftingandmitralvalvereplacementinahivpositivepatient AT sreekumarsubramanian highriskcoronaryarterybypassgraftingandmitralvalvereplacementinahivpositivepatient |