Left ventricular rupture following mitral valve replacement with a Hancock bioprosthesis

A rare complication of mitral valve replacement with the Hancock bioprosthesis was observed in three patients presenting with prevalent mitral stenosis and normally-sized left ventricular cavity. In the patients, a deep erosion of the left ventricular free wall was present which evolved into cardiac rupture in one of them. The laceration is ascribed to the friction between a prosthetic strut and the myocardium; a disproportion between the "high-profile" device and the left ventricular chamber is suggested to explain this complication, which may be avoided by employing a "low-profile" prosthesis.