Simultaneous Cardiac Resynchronization Therapy and Cardiac Surgery in a Patient with Triple Coronary Vessel Disease, Mitral and Tricuspid Valve Insufficiency after Three-Area Old Myocardial Infarction

(Department of Cardiovascular Surgery, Ayase Heart Hospital, Tokyo, Japan)

Takashi Miura Imun Tei Takashi Oshitomi
Kazuki Sato Eiichi Tei
We performed cardiac resynchronization therapy (CRT) in addition to coronary artery bypass grafting (CABG), mitral valve replacement (MVR) and tricuspid valve annuloplasty (TAP) in a 72-year-old patient with poor cardiac function (New York Heart Association functional class III, ejection fraction 38%), triple coronary vessel disease, and mitral and tricuspid valve insufficiency after three-area old myocardial infarction. Electrocardiography showed no change in the QRS interval after CRT. However, tissue Doppler echocardiography showed synchronicity of the septum and posterior segments in the left ventricle, and that contraction of the septum was in the systolic phase of the cardiac cycle after CRT. New York Heart Association functional class improved from III to I after the operation. CRT of the dyssynchronized myocardium in which ischemia and volume overload were improved by CABG, MVR and TAP may improve regional cardiac function and synchronicity.
@Jpn. J. Cardiovasc. Surg. 34: 220-224 (2005)