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Iatrogenic left ventricular-right atrial communication after tricuspid annuloplasty; a case report

Eiki Tayama1, Yukihiro Tomita, Ken-ichi Imasaka

  • 1Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-8563, Japan. e.tayama@kyumed.jp.

Journal of Cardiothoracic Surgery
|June 20, 2014
PubMed

Insights

A rare complication after tricuspid valve repair, a left ventricular-right atrial communication, caused mechanical hemolysis. Surgical closure of this defect successfully treated the condition.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Cardiovascular Medicine

Background:

  • A 75-year-old man presented with heart murmur and hemolytic anemia three months post-cardiac surgery.
  • Previous procedures included mitral valve annuloplasty, tricuspid annuloplasty, and coronary artery bypass grafting.

Observation:

  • A new systolic murmur was detected.
  • Echocardiography revealed a high-velocity jet from the left ventricular outflow tract to the right atrium.
  • A small left ventricular-right atrial defect was identified, with no mitral periprosthetic leaks.

Findings:

  • Surgical exploration identified a 3mm communication beneath a detached tricuspid prosthetic ring.
  • The defect was located at the anteroseptal commissure of the tricuspid valve.
  • The likely cause was an atrioventricular membranous septum tear from a misplaced tricuspid annuloplasty stitch.

Implications:

  • This case highlights a rare complication of tricuspid annuloplasty leading to a ventricular septal defect.
  • Surgical repair of the ventricular septal defect is crucial for resolving mechanical hemolysis.
  • Accurate stitch placement during tricuspid annuloplasty is vital to prevent iatrogenic defects.

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