A case of iatrogenic aortic valve leaflet perforation after closure of a ventricular septal defect

Abstract

Aortic regurgitation caused by leaflet perforation is most frequently seen in association with infective endocarditis that involves the aortic valve. There have been occasional reports of iatrogenic aortic regurgitation caused by aortic valve injury after cardiac surgery with the use of the transaortic approach or invasive cardiac procedures. Suture-related aortic valve injury can develop during periaortic cardiac surgery, but this has been very rarely reported. Inadvertent injury to an aortic valve leaflet caused by a stitching needle or surgical forceps can produce leaflet perforation with aortic regurgitation. This report describes a case of aortic regurgitation that was caused by iatrogenic aortic valve leaflet perforation, and this occurred in a 22-year-old woman who underwent repair of a ventricular septal defect (VSD) 15 years previously. Transthoracic echocardiography (TTE) showed a defect located at the aortic annulus close to the infundibular septum on a two-dimensional echocardiographic study and we observed an eccentric jet flow into the left ventricle in early diastole on the continuous wave and color flow Doppler studies. A small perforation in the body of the right aortic cusp and mild to moderate aortic regurgitation were confirmed by the use of transesophageal echocardiography (TEE) and ascending aortography.

Iatrogenic Aortic Valve Perforation after Ventricular Septal Defect Repair

“…1,2) AV perforation after VSDR is rare and mostly studied as the case reports. [4][5][6][7] We report three consecutive patients who suffered significant aortic leaflet injury in the noncoronary leaflet during VSDR procedure and referred for reoperation in our institution.…”

“…1) None of the three patients had significant AR before the first operation for VSD, Proper management of the iatrogenic complications by the surgeon is important. 4) The increased awareness of the complication results in avoidance of adverse surgical results while performing VSD repair, and improves the ability to repair iatrogenic leaflet perforation. AV repair is most commonly performed in patients with severe AR due to AV leaflet perforation.…”

“…More attention should be paid to the rare complications, and proper imaging techniques employed for diagnosis so as to intervene as soon as possible. 4) Continuous monitoring and documentation of AV function after a VSDR procedure is mandatory. In mild or moderate AR, careful observation is justified, while bearing in mind the risk and extent of redo operation.…”

“…The suture-related inadvertent injury to an AV leaflet can produce leaflet perforation with aortic regurgitation (AR) after ventricular septal defect repair (VSDR). 3,4) This injury results from the immediate anatomic vicinity of the AV, especially the right coronary leaflet and noncoronary leaflet. New onset of AR after a repair procedure on ventricular septal defect (VSD) can be the direct consequence of aortic leaflet perforation caused by the stitches.…”

Inadvertent Complication of Prosthetic Valve Surgery: Leaflet Perforation

“…However, the suture-related injury to an aortic or mitral valve can result in leaflet perforation with aortic or mitral regurgitation after such perivalvular surgeries (1)(2)(3)(4). Herein, we reported 2 cases of iatrogenic aortic and mitral valve leaflet perforation after prosthetic valve surgeries.…”