Perforation of the Anterior Mitral Leaflet After Aortic Valve Replacement With Root Enlargement

Abstract

A 32-year-old male patient was admitted to our hospital because of dyspnea and fatigue. He had a history of aortic valve replacement and a simultaneous Nicks procedure 4 years earlier because of a small aortic root and aortic regurgitation. Results of laboratory tests such as leukocyte count, C-reactive protein, and procalcitonin were normal. Blood cultures were sterile. Transthoracic echocardiography demonstrated severe mitral regurgitation. Subsequent transesophageal echocardiography detected a systolic jet flow on the anterior mitral leaflet and perforation (Figs 1A-1D [Ao ¼ aorta; Fig 1.

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]…”

“…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 extravalvular causes of MR (n = 6), 15,23,28,38,41,44,46 a foreign body was found to interfere with and damaged the otherwise healthy mitral valve. In 5 patients, 28,38,41,44,46 the implanted prosthetic aortic valve interfered with mitral valve function and damaged the anterior mitral valve leaflet (AMVL).…”