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[Rupture of the middle left ventricle after a mitral valve replacement. A report on 27 autopsy cases]
L Suchil Bernal1, A Osornio Vargas, C Fernández Barros
1Departamento de Patología, Instituto Nacional de Cardiología, Ignacio Chávez, México.
Abstract:
Left ventricular rupture is a serious complication of mitral valve replacement. The prevalence ranged from 0.5 to 14%, and is the principal cause of early postoperative death following mitral valve replacement. In this report we described certain morphologic observations and some clinical and epidemiological data of a series of 27 necropsy patients with midventricular rupture (type III). This complication was predominantly present in females (88.9%) with an average age of 44 +/- 11.4 years. The predominant valvular lesion was stenosis (70.4%). In all cases we found small-sized left ventricles and the ventricular wall hypertrophied. Perforation was observed in the 18.5% of the cases. In 59.2% of the patients high profile prostheses were used. Seventy-eight percent of patients died before 24 hours with refractory ventricular failure and only in the 25.9% of cases the clinical diagnoses was suspected and rupture unsuccessfully repaired. Our results suggested that age, sex, type of mitral lesion, ventricular size and type of prostheses are not risk factors for this complication. The mortality is high and the diagnosis was not suspected frequently. Midventricular rupture of the left ventricle is a lethal complication and is necessary to know all its characteristics to implement better methods of prevention and management.
Insights
Midventricular rupture of the left ventricle is a lethal complication after mitral valve replacement, often missed and leading to high mortality. Understanding its characteristics is crucial for prevention and management.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pathology
Context:
- Mitral valve replacement (MVR) carries a risk of left ventricular rupture, a major cause of early postoperative mortality.
- Midventricular rupture (Type III) is a rare but devastating complication with a prevalence of 0.5–14% after MVR.
Purpose:
- To describe morphologic observations and clinical/epidemiological data of midventricular rupture in 27 necropsy patients.
- To identify potential risk factors and understand the clinical presentation and outcomes of this complication.
Summary:
- The study analyzed 27 necropsy cases of midventricular rupture post-MVR, predominantly affecting females (88.9%) aged 44±11.4 years.
- Key findings include a high association with mitral stenosis (70.4%), small left ventricles with hypertrophy, and frequent use of high-profile prostheses (59.2%).
- Mortality was extremely high (78% died within 24 hours), often due to refractory ventricular failure, with low diagnostic suspicion (25.9%) and limited successful repair attempts.
Impact:
- Identified that age, sex, mitral lesion type, ventricular size, and prosthesis type were not significant risk factors.
- Emphasizes the high mortality and low diagnostic rate, underscoring the need for increased awareness and improved diagnostic and management protocols for midventricular rupture.
- This research is crucial for developing targeted prevention and treatment strategies to improve patient outcomes after mitral valve replacement.