Detachment of an Annular Patch Following the Manougian Procedure

Abstract

Detachment of the prosthetic patch material is a rare complication in the early postoperative period following a Manougian's procedure. We present the case of a young adult presenting with significant mitral regurgitation associated with a defect in the anterior mitral leaflet early after an uneventful Manougian's procedure performed with a prosthetic patch.

New or Worsened Mitral Regurgitation After Surgical Aortic Valve Replacement: A Systematic Review

“…Across all studies, a total of patients underwent SAVR. The type of prosthesis used differed between the included studies, with 13 3,20,21,[23][24][25][26]30,33,39,41,44,47 implanting a bioprosthesis, 8 15,16,19,29,34,35,40,42 implanting a mechanical prosthesis, and 3 1,36,37 implanting mechanical and biological protheses; 12 studies 22,27,28,31,32,38,43,45,46,[48][49][50] did not specify prosthesis type. The size of the implanted prosthesis ranged from 17 mm 45 to 27 mm 20,24 ; however, 14 studies 1,[27][28][29]31,32,36,37,43,[46][47]…”

“…Of the 207 reported cases of new or worsened MR, 138 patients presented with a worsened severity of MR 1,3,20,[25][26][27]30,32,33,[36][37][38]48 after SAVR, for a reported prevalence of 66.7%. Additionally, 16 patients who received SAVR developed new MR, 15,16,19,21,23,24,34,38,39,44,46,49,50 for a reported prevalence of 7.7%. The remaining 53 cases 22,28,29,31,35,42,45 of reported new or worsened MR could not be specifically categorized due to lack of detail regarding the patients' preoperative status.…”

“…The etiology of MR was reported for 120 3,15,16,[19][20][21][22][23][24][25][26][28][29][30][31]33,34,[39][40][41][42][43][44][45][46][47][48][49][50] of the 207 cases of new or worsened MR following SAVR (Table 3). Notably, the mechanism of new or worsened MR was unspecified in the remaining 87 patients.…”

“…1,27,32,36,37,42,43 Organic Etiology. A total of 15.97% (20/120) of reported MR were classified as organic (ie, Carpentier's Type I or Type II), with 70.00% (14/20) 15,16,19,22,23,28,31,34,41,44,46,49 being classified as Type I, and 30.00% (6/20) 21,40,45,46 being classified as Type II. Of the 20 cases of organic MR (ie, Carpentier's Type I and Type II), 30.00% (6/20) 15,23,28,38,41,44,46 were thought to be caused by an extravalvular mechanism, and 70.00% (14/20) 16,19,21,22,31,37,40,45,46,49 by an intravalvular mechanism.…”

“…For the intravalvular causes of MR (n = 14), 6 cases 22,34,45,46 resulted from degeneration of a synthetic Manouguian patch along the anterior aspect of the mitral valve was found to occur following SAVR with aortic annulus enlargement with the Manouguian procedure. For clarification, the Manouguian procedure involves enlarging the aortic valve ring through an extended incision into the anterior mitral leaflet and suturing a patch to allow for placement of a larger prosthetic valve.…”