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Intraoperative left ventricular perforation with false aneurysm formation
Abstract:
Two cases of perforation of the left ventricle during mitral valve replacement are described. In the first case there was perforation at the site of papillary muscle excision and this was recognized and successfully treated. However, a true ventricular aneurysm developed at the repair site. One month after operation rupture of the left ventricle occurred at a second and separate site on the posterior aspect of the atrioventricular ring. This resulted in a false aneurysm which produced a pansystolic murmur mimicking mitral regurgitation. Both the true and the false aneurysm were successfully repaired. In the second case perforation occurred on the posterior aspect of the atrioventricular ring and was successfully repaired. However, a false ventricular aneurysm developed and ruptured into the left atrium producing severe, but silent, mitral regurgitation. This was recognized and successfully repaired. The implications of these cases are discussed.
Insights
Left ventricle perforation during mitral valve replacement can lead to true and false aneurysms. Early recognition and repair are crucial for successful outcomes in these rare complications.
Area of Science:
- Cardiac Surgery
- Cardiovascular Research
- Medical Case Reports
Background:
- Mitral valve replacement is a common cardiac procedure.
- Left ventricular perforation is a rare but serious complication.
- Understanding potential sequelae is vital for patient management.
Observation:
- Two cases of left ventricle perforation during mitral valve replacement are presented.
- Case 1: Perforation at papillary muscle excision site, followed by true aneurysm and later rupture forming a false aneurysm.
- Case 2: Perforation at the atrioventricular ring, leading to a false aneurysm rupturing into the left atrium.
Findings:
- Successful repair of both true and false left ventricular aneurysms was achieved in Case 1.
- Successful recognition and repair of a false left ventricular aneurysm causing silent mitral regurgitation in Case 2.
- Post-perforation aneurysms can present with murmurs mimicking mitral regurgitation or silently.
Implications:
- These cases highlight the importance of vigilance for ventricular perforation during mitral valve replacement.
- Prompt diagnosis and surgical intervention are critical for managing post-perforation aneurysms.
- Awareness of potential aneurysm formation and rupture can improve surgical outcomes and patient safety.