Repair of Posterior Left Ventricular Aneurysm through Transatrial Approach

Abstract

Repair of posterior left ventricular ischemic aneurysms implies an extracardiac approach to reshape the ventricular geometry frequently associated with mitral surgery. A transatrial technique was described for lesions following mitral surgery or for subvalvular idiopathic cases. A transmitral approach was used for ischemic or traumatic pseudoaneurysm. We describe a case of postinfarction posterior true aneurysm with associated mitral incompetence. Both lesions were treated through an intracardiac approach. The posterior mitral leaflet was detached posteriorly to close the aneurysm with a patch, and the valve replaced sparing all subvalvular apparatus. This technique seems to be safe and allows to treat both lesions avoiding ventriculotomy.

Exclusion of a submitral pseudoaneurysm by a conservative transmitral approach - Surgical technique for an unusual disease

“…We decided on a transmitral approach to close the orifice from the inside of the left ventricle. Transmitral approach was first described for post-infarction pseudoaneurysm when the mitral valve was also replaced 12 . In this young woman, we aimed to preserve the mitral valve and took great care on performing a partial detachment-reattachment of the posterior mitral valve.…”

Exclusion of a submitral pseudoaneurysm by a conservative transmitral approa—Surgical technique for an unusual disease

“…Transmitral approach was first described for postinfarction pseudoaneurysm when the mitral valve was also replaced. 10 In this young woman, we aimed to preserve the mitral valve and took great care on performing a partial detachment-reattachment of the posterior mitral valve. The detachment of the posterior valve, already described by Miura et al, 3 gave access to the orifice just behind the annulus without being bothered by the subvalvular apparatus.…”

“…We decided on a transmitral approach to close the orifice from the inside of the left ventricle. Transmitral approach was first described for postinfarction pseudoaneurysm when the mitral valve was also replaced 10 . In this young woman, we aimed to preserve the mitral valve and took great care on performing a partial detachment‐reattachment of the posterior mitral valve.…”

Surgical treatment of post-infarction left ventricular pseudoaneurysm: Case series highlighting various surgical strategies

“…In this approach, the left atrium is opened, the mitral valve temporarily removed, and the neck of the pseudoaneurysm directly closed or covered with a patch [18]. This approach is indicated in sub mitral pseudoaneurysm [19] but also in other cases can be tempted [20].…”