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Cox-Maze III procedure with valvular surgery in an autopneumonectomized patient

Jin Hong Wi1, Ho-Ki Min2*, Do Kyun Kang2, Hee Jae Jun2, Youn-Ho Hwang2, Dong-Kie Kim3, Hyun Kuk Kim3, Hang Jea Jang3 and Il Rhee4

Author Affiliations

1 Central Physical Examination Center of Military Manpower Administration, Seoul, South Korea

2 Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, 875 (Jwadong) Haeundae-ro, Haeundaegu, Busan, 612-030, South Korea

3 Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea

4 Department of Internal Medicine, Dong-Eui Medical Center, Busan, South Korea

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Journal of Cardiothoracic Surgery 2012, 7:116  doi:10.1186/1749-8090-7-116

Published: 8 November 2012


Destructive pulmonary inflammation can leave patients with only a single functional lung, resulting in anatomical and physiological changes that may interfere with subsequent cardiac surgeries. Such patients are vulnerable to perioperative cardiopulmonary complications. Herein, we report the first case, to our knowledge, of an autopneumonectomized patient who successfully underwent a modified Cox-Maze III procedure combined with valvular repairs. The three major findings in this case can be summarized as follows: (1) a median sternotomy with peripheral cannulations, such as femoral cannulations, can provide an optimal exposure and prevent the obstruction of vision that may occur as a result of multiple cannulations through a median sternotomy; (2) a modified septal incision combined with biatrial incisions facilitate adequate exposure of the mitral valve; and (3) the aggressive use of intraoperative ultrafiltration may be helpful for the perioperative managements as decreasing pulmonary water contents, thereby avoiding the pulmonary edema associated with secretion of inflammatory cytokines during a cardiopulmonary bypass. We also provide several suggestions for achieving similar satisfactory surgical outcomes in patients with a comparable condition.

Arrhythmia therapy; Mitral valve repair; Pneumonectomy