胸骨後胃管再建した食道癌術後患者に対する完全鏡視下心臓手術

Total Thoracoscopic Cardiac Surgery in a Patient after Retrosternal Esophageal Reconstruction with Gastric Tube

食道癌手術で胸骨後胃管再建を行った患者に対し，胃管損傷を避けるため完全鏡視下右肋間小開胸アプローチで僧帽弁置換術＋三尖弁輪縫縮術＋maze手術を行ったので報告する．

A 74-year-old man who had undergone esophageal resection and retrosternal gastric tube reconstruction for esophageal cancer one year ago presented to our hospital with appetite loss, weight gain, and edema in both legs. He was diagnosed as having congestive heart failure secondary to mitral regurgitation, tricuspid regurgitation, and atrial fibrillation. The patient underwent total thoracoscopic mitral valve replacement, tricuspid valve annuloplasty, and maze procedure with resection of the left atrial appendage via the right intercostal mini-thoracotomy approach. Since we could not determine the cause of mitral regurgitation and the presence of the retrosternal gastric tube after his previous surgery, we were unable to evaluate the mitral regurgitation intraoperatively using transesophageal echocardiography. Consequently, we opted for mitral valve replacement instead of mitral valve plasty. In patients who have undergone retrosternal gastric tube reconstruction, minimally invasive cardiac surgery via right mini-thoracotomy is effective in reducing the risk of gastric tube injury.