Iatrogenic Aortic Incompetence After Mitral Valve Replacement

Mehta, Anand; Hunsaker, Robert P.

doi:10.1053/j.jvca.2006.05.007

Cited by 17 publications

(15 citation statements)

References 3 publications

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“…Mehta and Hunsaker [ 5 ] reported severe AI due to a suture inadvertently placed in the left coronary cusp in a 79-year-old woman who underwent MV repair using Carpentier-Edwards annuloplasty ring insertion for severe MR. She underwent AV replacement with a porcine prosthesis; however, she died of excess intraoperative bleeding.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Aortic Insufficiency Following Mitral Valve Replacement: Case Report and Review of the Literature

2015

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We report a 28-year-old white female who suffered significant aortic insufficiency (AI) following mitral valve (MV) replacement for endocarditis. The patient had history of rheumatoid arthritis and presented to our emergency department with a 3-month history of dyspnea, orthopnea, fevers and weight loss, worsening over 2 weeks, for which she took intermittent acetaminophen. On admission, vital signs revealed blood pressure of 99/70 mm Hg, heart rate of 120 beats/minute, and temperature of 98.8 °F; her weight was 100 lbs. Physical exam revealed a thin and pale female. Cardiac auscultation revealed regular tachycardic rhythm with a third heart sound, and a short early systolic murmur at the left lower sternal border without radiation. Lungs revealed right lower lobe rhonchi. Initial pertinent laboratory evaluation revealed hemoglobin 9.6 g/dL and white blood cell count 17,500/μL. Renal function was normal, and hepatic enzymes were mildly elevated. Chest radiogram revealed right lower lobe infiltrate. Blood cultures revealed Enterococcus faecalis. Two-dimensional echocardiogram revealed large multilobed vegetation attached to the anterior MV leaflet with severe mitral regurgitation (MR), otherwise normal left ventricular systolic function. She was started on appropriate antibiotics and underwent MV replacement with 25-mm On-X prosthesis. She was noted post-operatively to have prominent systolic and diastolic murmurs. Repeat echocardiogram revealed normal mitral prosthesis function, with new moderately severe AI. Transesophageal echocardiogram revealed AI originating from a tethered non-coronary cusp, due to a suture preventing proper cusp mobility. The patient declined further surgery. She recovered slowly and was discharged to inpatient rehabilitation 4 weeks later. This case highlights the importance of vigilance to this potential serious complication of valve surgery with regard to diagnosis and treatment to prevent long-term adverse consequences.

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Section: Discussionmentioning

confidence: 99%

Iatrogenic Aortic Insufficiency Following Mitral Valve Replacement: Case Report and Review of the Literature

2015

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“…However, due to its central location, injury to the aortic valve can occur during many cardiac procedures. Such injury has been most commonly reported as a result of accidental suture placement or laceration by a needle with sutures placed near the aortic annulus but has also occurred during guide-wire passage and from tension on the leaflet intraoperatively [2, 3]. Though iatrogenic injury to the aortic valve is rare, it is most commonly associated with procedures involving the mitral valve given its anatomic proximity to the non-coronary and left coronary cusps.…”

Section: Discussionmentioning

confidence: 99%

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

Oakley

Love

Ramirez

et al. 2013

Case Reports in Cardiology

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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.

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“…Ducharme et al (1999) reported a case of severe aortic regurge after mitral valve repair caused by the tension of mitral ring on aortic annulus and the regurge was corrected during the operation by releasing 3 sutures on the mitral annular ring. Mehta and Hunsaker (2007) reported a case of intraoperative severe aortic regurge due to inadvertently placed suture through aortic left coronary cusp during mitral valve replacement and the patient was treated with aortic valve replacement.…”

Section: Discussionmentioning

confidence: 99%

Aortic Valve Leaflet Perforation after Mitral Valve Repair

Aboelnasr

Rohn

2013

Prague Med. Rep.

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R e c e i ve d D e c e m b e r 9 , 2 0 1 2 ; A c c e p t e d A u g u s t 1 4 , 2 0 1 3 . Key words: Aortic regurgitation -Aortic valve perforation -Mitral valve repairAbstract: A 32-year-old patient with symptomatic severe aortic regurge, 6 weeks after mitral valve repair, was admitted for aortic valve surgery. No preoperative clinical data consistent with infective endocarditis could be detected. Preoperative transthoracic echocardiography showed aortic leaflet perforation affecting non coronary cusp. During operation, leaflet perforation was detected and closed completely with autologous pericardial patch. No vegetations or abscess could be seen during operation. Iatrogenic aetiology of leaflet perforation after mitral repair was suspected in this case. Recognition of this complication will help in avoiding it during mitral valve surgery and expecting it as a possible complication during intraoperative transesophageal echocardiography.

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Iatrogenic Aortic Incompetence After Mitral Valve Replacement

Cited by 17 publications

References 3 publications

Iatrogenic Aortic Insufficiency Following Mitral Valve Replacement: Case Report and Review of the Literature

Iatrogenic Aortic Insufficiency Following Mitral Valve Replacement: Case Report and Review of the Literature

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

Aortic Valve Leaflet Perforation after Mitral Valve Repair

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