Cor Vasa 2012, 54(9-10):e295-e299 | DOI: 10.1016/j.crvasa.2012.09.002

Is it possible to operate four heart valves in a patient with heart failure, congenital heart disease and pulmonary hypertension?

Marie Zvěřinová^a,*, Jana Popelová^a,c, Petr Pavel^a, Roman Gebauer^a,c, Pavel Jehlička^a, Miroslav Rubáček^a, Milan Čech^b, Štěpán Černý^a

^a Kardiocentrum, Nemocnice Na Homolce, Praha, Česká republika

^b Interní oddělení, Nemocnice Na Homolce, Praha, Česká republika

^c Dětské kardiocentrum, Fakultní nemocnice Motol, Praha, Česká republika

We describe a 60-year-old man with the history of radical correction of the tetralogy of Fallot (TOF) in the year 1964. This patient has had a long lasting decompensation of a severe right heart failure with ascites and pulmonary hypertension. On echocardiography he had residual mild pulmonary stenosis (PS) and severe pulmonary and tricuspid regurgitation (TR), moderate aortic and mitral regurgitation. He also had residual ventricular septal defect (VSD) and severe pulmonary hypertension with the maximal gradient on TR 83 mmHg. He was considered unoperable by his cardiologist, however, the patient decided to undergo a high-risk operation. The operation comprised pulmonary and aortic valve replacement with bioprosthesis, mitral and tricuspid repair, closure of ventricular septal defect, bilateral MAZE and volumereduction of both atria. After a very complicated postoperative course with multiorgan failure he recovered and was discharged home 2 months after operation. The NYHA class improved from IV before operation to II. Twenty months after this operation he experienced infective endocarditis with a leak on the aortic bioprosthesis. He was reoperated with reimplantation of a new aortic bioprosthesis and with a very complicated postoperative course. Sildenafil was added to his therapy due to the persistent severe pulmonary hypertension. He survived and was discharged home. The presented unique high-risk complex reoperation of a congenital heart disease with pulmonary hypertension can be performed only by a very experienced cardiosurgical and cardio-anesthesiological team with a high level of the early and late postoperative care.

Keywords: Heart failure; Operation of adult with congenital heart disease; Pulmonary hypertension; Sildenafil; Tetralogy of Fallot

Received: May 28, 2012; Revised: August 28, 2012; Accepted: September 1, 2012; Published: September 1, 2012  Show citation