Surgical considerations in reoperations for mitral valvular diseases

Seven patients who underwent reoperations for mitral valvular diseases in recent 2 years were presented. Three patients woth restenosis after open mitral commissurotomy, and 4 patients with prosthetic valve dysfunction were performed mitral valve replacements using Bjork-Shilley tilting disk valve. Preoperative functional status (NYHA) was class III in 5 and class VI in 2. Urgent operations were necessary for two patients who has massive regragitation due to bioprosthetic valve dysfunction, and balled thrombus in the left atrium with an episode of embolism. Redo median sternotomy and intraoperative myocardial protection are major problems in reoperation. There were no hospital death and serious complication during periolerative period. Careful preparations for instituting cardiopulmonary bypass and operative techniques may minimize blood loss, and adewuate expisure of the heart effective to topical hypothermia may provide wxcellent myocardial protection.