Isolated Mitral Valve Replacement and Ventricular Rupture: Presentation of 6 Patients

Value of combined cross sectional and Doppler echocardiography in the detection of left ventricular pseudoaneurysm after mitral valve replacement.

“…The findings were nonspecific, suggesting overload of the left ventricle' enlargement of the left atrium and left ventricle,6 an "abnormal posterior area",7 or pericardial effusion. 8 Recently, Carlson et al described the first patient in whom a postoperative submitral pseudoaneurysm was detected by cross sectional echocardiography.3 Our report supports their experience and also shows the usefulness of a complementary Doppler examination. Together these three ca-ses show on cross sectional echocardiography that a postoperative left 55 ventricular pseudoaneurysm typically presents as a posterolateral echo-free extracardiac cavity.…”

A Treatise on The Surgical Management and A Suggested Amendment of Surgical Classification of Left Ventricular Rupture Following Mitral Valve Replacement

“…The incidence ranged from 0.5% of 1154 MVR by Zacharias and coworkers to 14% of 14 procedures performed by Stephenson and associates . Pooling of the data from 12 institutions on 12,988 patients undergoing MVR revealed a 0.74% incidence of left ventricular rupture (Table 1) [2,3,7,8,18,19,22,[26][27][28]. In a series of 5449 patients who underwent MVR from 1995 through 2003, Zhang and colleagues reported a 0.24% prevalence of LV rupture in association with a 61.5% mortality rate [15].…”

“…Collected data from the published literature identified 108 patients for whom the classification was possible; 50 had type I and 58 had type II or III ruptures. The overwhelming majority of the ruptures in these 58 patients were type III [2,3,7,8,18,19,22,[26][27][28]. Failure of transapical off-pump mitral valve repair with Neo-chordal implantation (DS 1000; NeoChord Inc, St. Louis Park, Minnesota, USA) have introduced a new subset of patients with rupture site located between the base of the papillary muscle and ventricular apex [17].…”

“…Pre-existing intrinsic myocardial disease especially rheumatic, ischemic, infectious processes and renal failure requiring hemodialysis have also been implicated. Hypothermic cardioplegia has been implicated in left ventricular rupture through: i) increased susceptibility of the cardiopleged muscle to stretch injury [11,12] [2,3,7,8,18,19,22,[26][27][28]. In this entire group, only the bioprosthesis was directly implicated in initiating the myocardial injury.…”

“…Although there are isolated reports of repair of small focal perforations by external approach alone, the external rupture may represent the "tip of an iceberg" giving little clue to the extent of the underlying ventricular rupture. With midventricular ruptures, the tear has often been 4 to 5 cm in length [11][12][13][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Sparing the left circumflex coronary artery and its major marginal branches [7,8].…”