Aortic Valve Replacement With Mitral and Tricuspid Valve Repair Via a Right Anterior Thoracotomy

A 64-year-old male presented with complaints of severe dyspnea on minimal exertion, lower extremity edema, and weakness. The patient had a history of long-term atrial fibrillation (AF). 

Echocardiography revealed reduced left ventricular ejection fraction, moderate to severe aortic valve stenosis with a mean gradient of 31 mmHg, and an aortic valve area (AVA) of 0.9 cm². Severe mitral and tricuspid regurgitation were also noted. Contrast-enhanced CT demonstrated cardiac chamber enlargement, aortic valve calcification, coronary calcium, and moderate atherosclerotic involvement of the descending aorta. Coronary angiography showed no hemodynamically significant coronary artery stenoses. 

After cardiac arrest, the left atrium was opened to expose the mitral valve. Intraoperative assessment revealed annular dilation of the mitral valve. A 30 mm annuloplasty band was implanted. The next step involved intervention on the aortic valve. The aortic valve inspection revealed a tricuspid valve with significant calcification. The valve was excised, and a biological 23 mm aortic prosthesis was implanted using pledgeted interrupted sutures. A right atriotomy was performed to expose the tricuspid valve, which showed significant annular dilation. A suture annuloplasty was performed with interrupted stitches. 
Intraoperative transesophageal echocardiography (TEE) confirmed good right and left ventricular function, no paravalvular leakage of the aortic prosthesis, and no mitral or tricuspid regurgitation. 

The postoperative period was uneventful. The total length of hospital stay was five days, including one day in the ICU. 

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