Use of bioprosthetic valve in women of reproductive age and elderly patients—A good option

Abstract

Background: Cardio pulmonar T bypass and open heart surgery necessary for mitral valve replacement is routine procedme in any cardiac center. When it is associated with polyendocarinopathies like hypothyroidism, diabetes and right adrenal tumor it becomes quite complicated and difficult to manage.Case Report: A forty nine year old female, known to have hypertension, hypothyroidism and insulin dependent diabetes mellitus presented in OPD, for mitral valve replacement for mitral valve restenosis following closed mitral commissmotomy. All preoperative routine investigation were performed to rule out any associations of multiple endocrine neoplasia syndrome (MEN). Out of these investigations right adrenal tumor was detected on abdominal ultrasonography. Biochemical and noninvasive investigations revealed right adrenal tumor as a phaeochromocytoma preoperatively. Standard protocol for preoperative management of control of hypertension was followed over two weeks before surgery. It was decided to tackle both the operations at the same sitting. Intially right adrenal tumor was excised through roof top incision. The haemodynamic stability was maintained with an array of inotropic support. The insulin protocol for diabetes was started dming surgery. Mitral valve replacement was performed as usual through left atrial approach. Postoperative period was stormy. Wound was healthy. The patient was discharged after 3rd week of surgery. She was followed up to six months. The adrenal tumor was found to be globular, firm and yellowish red in colour. Histopathological examination revealed myelolipoma. Successful management of this complicated case is being presented here. on the 7th post op day having made an uneventful recovery. There was no complication related to the axillary artery cannulation.Conclusions: This technique could be used for a select group of patients who are at high risk of repeat stemotomy and axillary artery cannulation would be useful in cases with severely calcified ascending aorta.