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Left ventricular rupture as a complication of mitral valve replacement
The Journal of Thoracic and Cardiovascular Surgery
|January 1, 1977
Summary
Repairing left ventricular rupture after mitral valve replacement is challenging. Prompt extracorporeal circulation and careful surgical technique improve survival, especially for intraoperative Type II ruptures.
Area of Science:
- Cardiovascular Surgery
- Cardiac Repair Techniques
- Mitral Valve Replacement Complications
Background:
- Left ventricular rupture is a rare but serious complication following mitral valve replacement.
- Previous literature reports 18 cases, with limited data on management and outcomes.
Observation:
- This series includes 8 patients with left ventricular rupture post-mitral valve replacement, with 5 survivors.
- Ruptures were classified as Type I (posterior atrioventricular groove laceration) or Type II (mid-left ventricle perforation).
- Intraoperative ruptures (17/26) were detected upon bypass termination, while delayed ruptures (9/26) occurred post-operatively.
Findings:
- Mortality was approximately 50% for intraoperative ruptures and 100% for delayed ruptures.
- Intraoperative Type II lesions had the best prognosis.
- Key prognostic factors included immediate re-institution of extracorporeal circulation and avoiding the circumflex coronary artery in Type I repairs.
Implications:
- Suturing on a beating heart is ineffective and can worsen tears.
- Type I lacerations may benefit from left atrial repair, while Type II perforations are best repaired directly from the exterior.
- Angulated metal cannulas for left ventricular drainage may cause myocardial perforation, suggesting the use of softer or differently angled cannulas.