Transmitral endoventricular repair of left ventricular pseudoaneurysm following mitral valve replacement

Left ventricular (LV) pseudoaneurysm is a rare but serious complication of mitral valve replacement and is usually the consequence of atrioventricular separation. Although there may be a role for nonoperative treatment in the presence of a small false aneurysm and in the absence of paravalvular leak, the presence of a large false aneurysm usually mandates surgical intervention. This may be hazardous in patients with concomitant LV dysfunction. We report a case of a patient who presented with a large LV pseudoaneurysm following numerous attempts of mitral valve replacements for a variety of reasons, including endocarditis. Some of the technical details of aneurysm repair and aspects of myocardial protection are discussed. In our patient, avoidance of cardioplegic arrest may have contributed to the successful outcome.