Subvalvular left ventricular aneurysm following mitral valve replacement

Two cases are presented which represent different aspects of damage to the posterior wall of the left ventricle following mitral valve replacement. In the first case rupture of the ventricle occurred in the immediate postoperative period with a fatal result, while in the second, delayed aneurysm formation occurred with embolic and haemodynamic complications. This patient also did not survive. A review of the literature reveals four similar cases previously recorded. Possible aetiological factors are considered, including operative trauma, ischaemic damage, rupture of unsupported muscle, previous surgery with the development of pericardial adhesions and fixing of the valve ring, and finally abscess formation. The indications for operative intervention and possible complications of the aneurysm are noted.