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Delayed left ventricular rupture after mitral valve replacement
Abstract:
Posterior left ventricular rupture (LVR) is a serious complication following mitral valve replacement (MVR), especially if occurring postoperatively with the chest already closed or the patient in the intensive care unit. Only one of the patients with this delayed type of LVR reported earlier has been treated successfully. Our experience consists of 4 such complications among 161 MVR patients, the incidence being 2.5%. Two of these patients survived. Mechanical factors seem to constitute the most important etiologic causes for this complication. Immediate reoperation must be performed, and extracorporeal circulation is generally mandatory for successful repair. The reconstruction of the ruptured posterior left ventricular wall in both surviving patients was performed from the epicardial surface of the heart using pledget sutures. The auricle of the left atrium was used to cover the site of the tear when bleeding was not stopped with pledget sutures. It usually seems possible to avoid this complication if all mechanical etiologic factors are taken into consideration. After successful correction, a pseudoaneurysm may arise and, for that reason, a cardiac echo sonography follow-up is recommended.
Insights
Posterior left ventricular rupture (LVR) after mitral valve replacement (MVR) is rare but serious. Successful repair requires immediate reoperation, often with extracorporeal circulation, and careful attention to mechanical factors.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Complications
- Mechanical Circulatory Support
Background:
- Posterior left ventricular rupture (LVR) is a severe complication post-mitral valve replacement (MVR).
- Delayed LVR, occurring postoperatively with the chest closed or in intensive care, has a historically poor survival rate.
- This study investigates the incidence and management of delayed LVR following MVR.
Observation:
- Four cases of posterior LVR were identified among 161 MVR patients, an incidence of 2.5%.
- Two of the four patients with delayed LVR survived.
- Mechanical factors were identified as the primary etiologic cause.
Findings:
- Immediate reoperation is crucial for managing posterior LVR.
- Extracorporeal circulation is generally mandatory for successful repair.
- Surgical repair involved epicardial pledget sutures, with left atrial appendage used for coverage when needed.
Implications:
- Preventing mechanical etiologic factors can reduce the incidence of LVR.
- Post-successful repair, cardiac echo sonography follow-up is recommended to monitor for pseudoaneurysm formation.
- This experience highlights a viable surgical approach for a previously high-mortality complication.