Cardiac Gated Computed Tomography Used to Confirm Iatrogenic Aortic Valve Leaflet Perforation after Mitral Valve Replacement

Abstract

Aortic insufficiency from iatrogenic valve perforation from nonaortic valve operations is rarely reported despite the prevalence of these procedures. Rapid diagnosis of these defects is essential to prevent deterioration of cardiac function. In this paper, we describe a young man who reported to our institution after two open cardiac surgeries with new aortic regurgitation found to be due to an iatrogenic perforation of his noncoronary aortic valve cusp. This defect was not appreciated by previous intraoperative transesophageal echocardiography and was inadequately visualized on follow-up transthoracic and transesophageal echocardiograms. In contrast, cardiac gated computed tomography clearly visualized the defect and its surrounding structures. This case highlights the utility of cardiac gated computed tomography for cases of suspected valvular perforation when echocardiography is not readily available or inadequate imaging is obtained.

Iatrogenic Acute Aortic Insufficiency Following Mitral Valve Replacement

“…The typical imaging findings using TEE are echo dropout in the body of the cusp and an eccentric regurgitant jet. The origin of regurgitant flow can be confirmed using a short-axis view and three-dimensional TEE [7].…”

Iatrogenic non-coronary leaflet perforation as a complication after robotic mitral valve repair

“…Partial rings can potentially decrease the risk of aortic valve injury as the portion of the anterior annulus between both trigonal areas does not necessitate any stitch placement. In all previously reported articles, AR resulted from tethering of left or non-coronary leaflet due to an inadvertently placed suture preventing proper cusp mobility [ 2 , 4 , 6 , 7 , 13 ] or perforation of one of the three aortic leaflets tackled by an improperly orientated needle during its passage through the anterior mitral annulus [ 3 , 5 , 8 , 9 , 11 , 12 , 14 ]. The non-coronary leaflet is more likely to suffer from injury than the left and right coronary leaflets.…”

A rare complication of mitral valve replacement: Iatrogenic aortic valve perforation

“…In severe regurgitation, urgent intraoperative correction can be necessary . Repair of these injuries can be done by release of the offending stitch, valve repair, or valve replacement . In our patient, intraoperative TEE was not performed and the iatrogenic moderate and well tolerated AR was detected immediately after the operation.…”