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Ventricular Perforation During Open Surgical Balloon Expandable Mitral Valve Replacement: A Case Report
Yousef M Hamdeh1, Jordan E Goldhammer, Nicholas J Ruggiero
1From the Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
A & a Case Reports
|July 12, 2017
Summary
A rare complication occurred during open-heart surgery for mitral valve replacement. The valve delivery system caused a left ventricular apex laceration, highlighting risks unique to surgical approaches.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Device Technology
Background:
- Severe mitral annular calcification necessitates valve replacement.
- Transcatheter aortic valve replacement (TAVR) and mitral valve replacement (TMVR) are evolving procedures.
- Open surgical approaches for mitral valve replacement carry inherent risks.
Observation:
- A 79-year-old woman underwent open surgical mitral valve replacement using a SAPIEN 3 valve.
- Post-cardiopulmonary bypass, unidentified bleeding was detected.
- A laceration of the left ventricular apex was identified as the source of bleeding, attributed to the valve delivery system.
Findings:
- The open surgical approach for mitral valve implantation presented specific risks.
- Factors include a decompressed ventricle, reduced annulus-to-apex distance, and lack of continuous imaging.
- These conditions increased the risk of ventricular perforation compared to transcatheter methods.
Implications:
- This case underscores the potential for ventricular injury during open surgical mitral valve replacement.
- Careful patient selection and procedural technique are crucial to mitigate risks.
- Further research into device-related complications in surgical valve implantation is warranted.
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