[Aortic valve replacement and ventricular septal defect closure after previous bilateral internal thoracic artery bypass grafting; report of a case].

The patient was a 74-year-old man with a history of ventricular-septal defect (VSD). He underwent coronary artery bypass grafting (CABG), which was performed using the bilateral internal thoracic artery (ITA) 9 years ago. Since 2009, he experienced heart failure, and in 2011, he started administration of tolvaptan, vasopressin V2 receptor antagonist. In 2011, he developed fever, and follow-up echocardiography revealed moderate aortic regurgitation and vegetation around the VSD and the aortic valve. Therefore, we performed redo-aortic valve replacement (AVR) and VSD closure. Both ITAs were carefully dissected and were clamped during cardiac arrest. The patient was discharged on the 36th postoperative day, without tolvaptan. AVR and VSD closure after bilateral ITA bypass grafting is a challenging procedure if the patent ITA crosses the midline. Patent ITA should be occluded to avoid cardioplegia washout during aortic cross-clamping. Multi-detector-row computed tomography (MDCT) enables excellent imaging for dissecting ITA grafts.