Why the New Severe Aortic Insufficiency After Mitral and Tricuspid Valve Repair?

Iatrogenic non-coronary leaflet perforation as a complication after robotic mitral valve repair

“…Partial rings can potentially decrease the risk of aortic valve injury as the portion of the anterior annulus between both trigonal areas does not necessitate any stitch placement. In all previously reported articles, AR resulted from tethering of left or non-coronary leaflet due to an inadvertently placed suture preventing proper cusp mobility [ 2 , 4 , 6 , 7 , 13 ] or perforation of one of the three aortic leaflets tackled by an improperly orientated needle during its passage through the anterior mitral annulus [ 3 , 5 , 8 , 9 , 11 , 12 , 14 ]. The non-coronary leaflet is more likely to suffer from injury than the left and right coronary leaflets.…”

“…The non-coronary leaflet is more likely to suffer from injury than the left and right coronary leaflets. Out of the total 19 patients previously presented in the literature, 13 had injury of the non-coronary leaflet [ 2 , 3 , 8 , 9 , 11 – 13 ], 5 had that of the left coronary leaflet [ 3 – 7 ], and one had that of the right coronary leaflet [ 14 ]. In our case, the mechanism of progressive AR was probably due to the gradual increase of the non-coronary leaflet tear, as was previously described by Lakew et al in three patients who underwent minimally invasive MVR [ 9 ].…”

“…The mitro-aortic intervalvular fibrosa ensures the continuity between the anterior mitral leaflet and mainly the left and non-coronary aortic leaflets and therefore plays an essential role in both valves’ anatomic and functional integrity [ 1 ]. Surgical sutures anchoring the mitral annuloplasty ring or prosthesis on the anterior annulus may cause left or non-coronary aortic leaflet injury [ 2 – 13 ] more often than that of the right leaflet [ 14 ], leading to aortic regurgitation (AR). As minimally invasive access to the mitral valve is becoming more widely used, this potential complication should be more carefully evaluated in the patients’ intraoperative, early, and midterm echocardiographic outcomes [ 9 ].…”

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

“…Repair of other congenital heart lesions in close proximity to the AV may also place the aortic valve at risk of cusp tethering or perforation. Pagel et al [ 11 ] reported a case of endocardial cushion defect undergoing mitral and tricuspid valve repair, resulting in iatrogenic AI due to tethering of the non-coronary cusp by mitral annuloplasty sutures. Rey et al [ 12 ] reported eight children with repaired ostium primum atrial septal defects (ASDs) causing perforation of the non-coronary cusp of the AV and resulting in varying degrees of AI, some requiring surgical intervention.…”