[Left ventricular perforation after insertion of a mitral prosthesis. 6 cases]

Area of Science:

• Cardiac Surgery
• Cardiovascular Research
• Biomedical Engineering

Background:

• Mitral valve replacement is a common procedure.
• Left ventricular rupture is a rare but severe complication.
• Understanding rupture mechanisms is vital for prevention.

Observation:

• External ruptures of the left ventricle can manifest within 12 hours post-surgery or be delayed up to a month or later.
• Hemorrhage or cardiac failure are critical indicators of early rupture.
• Traumatic accidents may arise from direct ball valve impact or sub-annular splitting during calcified valve excision.

Findings:

• Two primary mechanisms contribute to left ventricular rupture: direct valvular trauma and sub-annular splitting.
• Prosthetic valve choice is critical, favoring disc valves in cases of small left ventricles with calcified mitral valves.
• Meticulous decalcification of the mitral ring and careful valvular resection, potentially leaving a calcified cuff, can enhance safety.

Implications:

• Understanding these mechanisms aids in preventing rare but severe left ventricular ruptures post-mitral replacement.
• Adherence to specific surgical strategies can mitigate risks associated with mitral valve surgery.
• Improved patient safety and outcomes are achievable through precise surgical technique and device selection.