Transverse midventricular disruption after mitral valve replacement

Cobbs, B.Woodfin; Hatcher, Charles R.; Craver, Joseph M.; Jones, Ellis L.; Sewell, Charles W.

doi:10.1016/0002-8703(80)90312-9

Cited by 70 publications

(31 citation statements)

References 11 publications

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“…[5][6][7][8] In the present case, traction of the heart during hemostasis of the LA suture line was a major cause of the ventricle rupture, as Björk suggested. 6 Additionally, a relatively small body size, small LA subsequent to LA reduction procedure, and the relatively large size of the prosthesis might also be associated.…”

Section: Discussionmentioning

confidence: 50%

Repair of Left Ventricular Rupture Following Mitral Valve Replacement Concomitant With Left Atrial Reduction Procedure

et al. 2001

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eft ventricular (LV) rupture is one of the most severe complications after mitral valve replacement (MVR). Although its occurrence is rare, it is potentially lethal. The present report describes successful repair of a type 1 LV rupture, which occurred after MVR concomitant with a left atrial (LA) reduction procedure, by combination of an intracardiac patch repair and an extracardiac buttress suture. Case ReportA 64-year-old woman, who was diagnosed with mitral stenosis with atrial fibrillation resulting from rheumatic fever, underwent percutaneous mitral comissurotomy. After this procedure, severe mitral regurgitation occurred. The patient subsequently underwent mitral replacement and LA reduction in May 1999.The operation was performed with a cardiopulmonary bypass and intermittent/continuous cold blood cardioplegia. The atrial incision was initiated from the right side of the LA, and an area of the pulmonary vein was circularly isolated. The middle third of the LA, including the LA appendage, was excised, as followed by a report by Sankar and Farnsworth. 1 The mitral valve was found to have developed fibrosis of the leaflet, and chordae shortening without calcification. There was a tear measuring 2 cm on the anterior leaflet, which was created by the percutaneous mitral comissurotomy. Both the anterior and the posterior leaflet were excised. The 27 mm ATS mitral prosthesis is fixed to the mitral annulas using interrupted mattress sutures. Japanese Circulation Journal Vol.65, June 2001After weaning from the cardiopulmonary bypass, a major bleeding was suddenly noted from the posterior area of the heart during the hemostasis of the LA suture line. Simultaneously, the ST level was elevated on the II and V5 leads of the electrocardiogram. Because LV rupture was suspected, cardiopulmonary bypass was re-established immediately. Epicardial oozing and myocardial hematoma were recognized at the posterior left ventricular wall, but the Rupture of the posterior wall of the left ventricle after mitral valve replacement is a dire complication associated with a very high mortality. This study reports a successful repair of type 1 left ventricular rupture, which occurred after mitral valve replacement concomitant with a left atrial reduction procedure, by combination of an intracardiac patch and an extracardiac buttress suture. In a case such as this, in which hemostasis is quite difficult to establish, this combination technique is particularly effective. ( Full-thickness buttressed suture was placed on the epicardium while making an effort to avoiding circumflex artery injury. Additionally, fibrin glue/sheet and GRF glue on the Teflon sheet were used to enhance hemostasis.

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Section: Discussionmentioning

confidence: 50%

Repair of Left Ventricular Rupture Following Mitral Valve Replacement Concomitant With Left Atrial Reduction Procedure

et al. 2001

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“…Reoperation, endocarditis and an oversized prosthesis have been reported to predispose a patient to its formation. Minimal damage of the annulus or partial thickness endomyocardial disruptions of the LV may eventually cause a full-thickness defect late after MVR and this can develop into a LV pseudoaneurysm 4). It differs from a true aneurysm because the walls of the pseudoaneurysm consist of fibrous tissue and pericardium, and not myocardium.…”

Section: Discussionmentioning

confidence: 99%

A Case of Left Ventricular Pseudoaneurysm in the Left Atrioventricular Groove after Mitral Valve Replacement

Jung

Chung

Yang

et al. 2010

J Cardiovasc Ultrasound

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Left ventricle-coronary sinus fistula and left ventricular pseudoaneurysm are unusual and frightening complications after mitral valve replacement. A 27-year-old female patient underwent mitral valve replacement 5 years previously and trans-thoracic echocardiography showed an outpouching lesion at the atrioventricular groove. It was difficult to differentiate whether the lesion was a left ventricle-coronary sinus fistula or a left ventricular pseudoaneurysm by two-dimensional echocardiography. Cardiac computed tomography confirmed a left ventricular pseudoaneurysm compressing the coronary sinus.

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“…Type III cited by Miller and colleagues 5 is in an intermediate zone between the base of the papillary muscle and the left atrioventricular groove, which is directly related to the "untethered loop" hypothesis proposed by Cobbs and colleagues. 6 Traditionally, type I rupture is treated by internal repair: removing the prosthesis and closing the tear with an endocardial patch. 1 Type II and III ruptures can be treated by external repair with multiple horizontal mattress stitches buttressed with Tefl on felt.…”

Section: Discussionmentioning

confidence: 99%

Fibrin Sealant for Left Ventricular Rupture after Mitral Valve Replacement

García-Villarreal

Casillas-Covarrubias

2008

Asian Cardiovasc Thorac Ann

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Despite safer surgical procedures, left ventricular rupture remains a rare but potentially lethal complication of mitral valve replacement. The use of fibrin sealant has substantially improved the outcome of many difficult bleeding episodes after cardiac surgery. We describe a case of left ventricular rupture successfully treated with fibrin sealant combined with external Teflon-pledgeted sutures.

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Transverse midventricular disruption after mitral valve replacement

Cited by 70 publications

References 11 publications

Repair of Left Ventricular Rupture Following Mitral Valve Replacement Concomitant With Left Atrial Reduction Procedure

Repair of Left Ventricular Rupture Following Mitral Valve Replacement Concomitant With Left Atrial Reduction Procedure

A Case of Left Ventricular Pseudoaneurysm in the Left Atrioventricular Groove after Mitral Valve Replacement

Fibrin Sealant for Left Ventricular Rupture after Mitral Valve Replacement

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