Mitral valve surgery in a patient with rheumatoid arthritis being treated with methotrexate

We describe our experience of mitral valve surgery in a 74-year-old man with rheumatoid arthritis (RA). RA had been diagnosed 12 years previously and his symptoms were being controlled by drugs including methotrexate (MTX), which is potentially immuno- and myelo-suppressive. He was admitted for dyspnea, and surgery was indicated for severe mitral insufficiency due to posterior leaflet prolapse. According to the recommendations of orthopedic surgeons, the administration of the MTX was discontinued at two weeks prior to the operation, in which the prolapsed leaflet was excised, repaired, and annuloplasty were performed with a 30mm prosthetics ring. The patient recovered uneventflully and MTX was resumed one week after surgery. Since MTX has been recently approval for treatment of RA in Japan, Japanese surgeons should pay attention to the appropriate perioperative use of this drug.