A Case Report of Esophagectomy for Esophageal Carcinoma after Mitral Valve Replacement

Osamu Konno, Zenjiro Watanabe, Atsushi Mutoh, Toshiyuki Takeshige, Takuro Saito, Yukio Endo, Hitoshi Inoue, Ryoichi Motoki, Yasushi Teranishi*

First Department of Surgery, Fukushima Medical College
*Department of Surgery, Ohu University

A few reports of patients who received esophagectomy for esophageal cancer after open heart surgery have been published. Therefore, we report a case in which esophagectomy was performed after mitral valve replacement, together with additional consideration of its postoperative management as reported in the literature. The patient is a 60-year-old man having retrosternalgia as the chief complaint, who was hospitalized in our Department for shock due to bleeding from a tumor after an endoscopic biopsy. After improvement of his general condition, various important organs were subjected to functional evaluation parallel to preoperative radiotherapy, then an operation was performed. It consisted of subtotal esophagectomy under right thoracotomy, and trans-posterior mediastinal lifting up of the gastric tube and its anastomosis to the cervical esophagus for reconstruction. The depth of invasion was a₃. The present case involved the following problems: 1) evaluation of preoperative heart function, 2) management of postoperative respiration and circulation, 3) anticoagulant therapy in case of nothing by mouth, 4) esophageal reconstructive route, etc. However, management of postoperative respiration and circulation by means of a Swan-Ganz catheter and anticoagulant therapy mainly with heparin made it possible for us to obtain good results without serious post operative complications. Nevertheless, 2 1/2 months after the operation, the patient died of bronchial invasion by local recurrent carcinoma.

Key words
major surgery after valve replacement, esophagectomy for esophageal carcinoma, anticoagulant therapy with heparin

Reprint requests
Osamu Konno First Department of Surgery, Fukushima Medical College
1 Hikarigaoka, Fukushima, 960-12 JAPAN

Accepted
October 11, 1989

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