Double Valve  Replacement & Coronary Bypass Surgery in Heavily Calcified Heart Valve disease patient.

• drpavankumar
• 0
• on Sep 30, 2022

K S 67 Yrs old male presented with Ant. Wall MI ( heart attack) on Investigations like Echo, it was found that he had Critical Aortic Stenosis with Dense Aortic Valve calcification , Mitral annular calcification with MS / MR & heavy calcification of left ventricular out flow.

Coronary Angiography showed severe calcified left main stem stenosis of 90% , calcified circumflex & RCA. Ascending Aorta showed calcified posterior wall. He was advised Double Heart Valve Replacement (DVR ) with 4 vessel Coronary Artery Bypass Surgery (CABG) .

He underwent DVR + CABG x 4 under TEE guidance at Lilavati Hospital by Dr. Pavan Kumar successfully. Operative findings showed heavily calcified Aortic Valve, Mitral Valve coronary arteries & posterior wall of  ascending Aorta. There was densely calcified blob below left Coronary sinus on left ventricular wall extending down. All these were carefully removed without damaging L.V. musculature. Aortic valve was replaced by # 19 Mechanical valve, & Mitral valve was replaced # 27 Mechanical valve & coronary arteries was bypassed by LIMA & Saphenous veins . Safe non-calcified Aortic wall was used for proximal Anastomosis . Patient was recovered smoothly with no complications & discharged on 7^th post operative day.

Discussion : – Double Heart Valve Replacement & multiple vessel CABG is very complex Heart Operation involving long time of Heart Arrest, Cardiopulmonary Bypass & Myocardial protection & safe recovery. This is further complicated by presence of heavy calcification in heart valve apparatus, Ascending Aorta, left ventricle & coronary arteries. Delicate dissection & removal of calcification without damaging heart muscles & nerves is of great importance. Coronary bypass grafting in calcified vessels also requires skills & experience. This patient had all these factors to tackle for successful outcome. Expertise of Dr. Pavan Kumar Senior Heart Surgeon with 30 yrs experience made this DVR + CABG x 4 possible without complication.