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Delayed left ventricular rupture after mitral valve replacement.

M Tarkka¹, R Pokela, P Kärkölä

¹Department of Surgery, University of Oulu, Finland.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery

|January 1, 1987

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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.

Related Experiment Videos

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.