[Left ventricular rupture following mitral valvular surgery]

During 10 years from 1979 to 1988, 99 patients underwent mitral valvular surgery in our clinic. Among 99 patients, we have experienced 3 cases of left ventricular rupture (3.0%). One of 3 patients survived after successful surgical repair. In patient 1, who underwent MVR, type I rupture occurred. The tears were immediately sutured on the beating heart. But 4 hours later, he died due to rerupture. The cause of rupture was suggested the high blood pressure following the trouble of respirator. In patient 2, who underwent OMC and AVR, type II rupture occurred. The cause of rupture was suggested to be the intimal injury of left ventricle with sucker or the excessive traction of papillary muscle. Fortunately, the bleeding was stopped after the mattress suture of tear from epicardial side under the beating heart. Subsequent rerupture did not occur and she could discharge from hospital 44 days later. In patient 3, who underwent AVR and MVR, type III rupture occurred. We restarted cardiopulmonary bypass and sutured the tears adding patch closure from the epicardial side on cardiac arrest. But she died two days later due to continuous bleeding. It is suggested that the stent of bioprosthesis injured the endocardium of left ventricle. In patient 1 and 3, we might have to repair the tear after the removal of prosthetic valve.