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Rupture of left ventricle following mitral valve replacement
K J Karlson1, M M Ashraf, R L Berger
1Division of Cardiovascular Surgery, New England Deaconess Hospital, Boston, MA.
Abstract:
A survey of the English language literature revealed 125 cases of left ventricular rupture following mitral valve replacement. In ten larger series, the incidence averaged 1.2%. Most of the ruptures were attributed either to technical maneuvers in the operation or to stretch injury produced by the untethering of the left ventricle through removal of the mural leaflet of the mitral valve. Preventive measures include modifications in operative techniques, containing pressure-volume work by the left ventricle, and probably retention of the posterior mitral leaflet. Surgical repair of the rupture with and without the aid of cardiopulmonary bypass resulted in 50% and 7% survival, respectively. With the use of cardiopulmonary bypass, external repair was followed by a 67% survival and the internal approach, by a 27% survival.
Insights
Left ventricular rupture after mitral valve replacement occurs in 1.2% of cases, often due to surgical technique or leaflet removal. Preventive strategies and specific repair methods significantly impact patient survival rates.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Mitral Valve Replacement Complications
Background:
- Left ventricular rupture is a rare but serious complication following mitral valve replacement.
- Previous literature suggests an incidence of approximately 1.2% in larger series.
Purpose of the Study:
- To review the incidence, causes, and outcomes of left ventricular rupture after mitral valve replacement.
- To identify potential preventive measures and assess the efficacy of different surgical repair strategies.
Main Methods:
- A comprehensive survey of English language literature was conducted.
- 125 cases of left ventricular rupture post-mitral valve replacement were identified and analyzed.
- Outcomes of surgical repair with and without cardiopulmonary bypass were compared.
Main Results:
- The average incidence of left ventricular rupture was 1.2%.
- Ruptures were primarily attributed to operative technicalities or stretch injury from leaflet removal.
- Surgical repair survival rates varied: 50% with cardiopulmonary bypass, 7% without. External repair with bypass yielded 67% survival, internal approach 27%.
Conclusions:
- Modifications in surgical techniques, managing left ventricular pressure-volume load, and potentially retaining the posterior mitral leaflet may prevent rupture.
- Cardiopulmonary bypass significantly improves survival rates for surgical repair, with external repair showing superior outcomes.