A Case of Quadruple Valve Replacement after Five-time Sternotomies for Corrected Transposition of the Great Arteries

Patients with severe and complex congenital heart diseases frequently require multiple repeat sternotomies. We recently performed cardiac surgery through the fifth sternotomy in a 29-year-old female patient with corrected transposition of the great arteries and pulmonary atresia. Previously, she underwent six cardiac operations, including four sternotomies. She also underwent double-switch operation and mechanical valve replacements for mitral and tricuspid positions. Eventually, she manifested repeated ascites, syncope, palpitation, and fatigue. Echocardiography, computed tomography, and cardiac catheterization detected severe left ventricular outflow tract stenosis, severe pulmonary valve insufficiency, and moderate aortic valve insufficiency. Hence, aortic and pulmonary valve replacement and release of the left ventricular outflow tract stenosis were performed, and all four cardiac valves were replaced with mechanical valves. Consequently, her postoperative course was unevent-ful, with remarkable attenuation of symptoms.