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Left ventricular rupture following mitral valve replacement due to oversize prosthesis
Makoto Kamada1, Kenji Ohsaka, Susumu Nagamine
1Department of Cardiovascular Surgery, Iwate Prefectural Central Hospital, Morioka, Iwate, Japan.
The Japanese Journal of Thoracic and Cardiovascular Surgery : Official Publication of the Japanese Association for Thoracic Surgery = Nihon Kyobu Geka Gakkai Zasshi
|January 18, 2005
Summary
Oversize mitral valve prostheses can cause serious left ventricular rupture after replacement surgery. Careful prosthesis selection is crucial to prevent this life-threatening complication during cardiac procedures.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomedical Engineering
Background:
- Mitral valve replacement is a common procedure for mitral restenosis.
- Left ventricular rupture is a rare but severe complication following mitral valve replacement.
- Prosthesis size is a critical factor in surgical outcomes.
Observation:
- A 67-year-old woman with prior mitral commissurotomy underwent mitral valve replacement with a 27 mm mechanical valve.
- Difficulties in prosthesis placement and a visible left ventricular bulge were noted due to the oversize prosthesis.
- Type III left ventricular rupture occurred after cardiopulmonary bypass cessation.
Findings:
- Successful surgical repair of the left ventricular rupture was achieved by suture closure.
- Replacement with a smaller, 23 mm valve resolved the issue.
- Postoperative echocardiography confirmed no prosthetic dysfunction or ventricular abnormalities.
Implications:
- Avoiding oversize prostheses during mitral valve replacement is essential to prevent left ventricular rupture.
- Careful intraoperative assessment of prosthesis fit is critical.
- This case highlights the importance of prosthesis-patient matching in cardiac surgery.