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Subannular perforation after long-lasting aortic valve replacement mimicking mitral insufficiency
Justus T Strauch1, Jens Wippermann, Henning Krep
1Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany. ju.strauch@gmx.de
The Annals of Thoracic Surgery
|December 25, 2007
Summary
A rare complication of mechanical aortic valve replacement is mitral insufficiency, caused by a defect in the mitral-aortic fibrosa. Surgical repair and bioprosthetic valve replacement successfully treated this rare condition.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Devices
Background:
- Mechanical aortic valve replacement is a common procedure for aortic valve disease.
- Complications can arise years after implantation, requiring careful monitoring and management.
- Mitral insufficiency is a potential, though rare, sequela following aortic valve surgery.
Observation:
- A patient developed severe mitral insufficiency 12 years post-mechanical aortic valve replacement.
- Transesophageal echocardiography revealed an eccentric systolic jet, indicating mitral regurgitation.
- Surgical exploration identified a defect in the mitral-aortic intervalvular fibrosa beneath the noncoronary sinus.
Findings:
- The defect in the mitral-aortic intervalvular fibrosa was the direct cause of the mitral insufficiency.
- Surgical intervention involved closing the defect with a pericardial patch.
- The patient subsequently received a stented pericardial bioprosthesis for aortic valve replacement.
Implications:
- This case highlights a rare but significant delayed complication of mechanical aortic valves.
- Accurate diagnosis requires advanced imaging like transesophageal echocardiography.
- Successful surgical management involves defect repair and valve replacement, offering a viable treatment option.
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