Left ventricular incision midway between the mitral anulus and the stumps of the papillary muscles during mitral valve excision with or without rupture or aneurysmal formation: analysis of 10 necropsy patients.
Certain clinical and morphologic observations are described in 10 patients who had mitral valve replacement (MVR) and lacerations of the left ventricular (LV) free wall midway between the anulus of the mitral valve and the stumps of the LV papillary muscles. In five patients the lacerations led to LV free wall rupture, with immediate hemopericardium in two and delayed (2 to 4 days) rupture in the other three. Of the other five patients, three developed aneurysm of the LV free wall, the mouth of which was located midway between mitral anulus and papillary muscle stumps, the sites of the lacerations observed in the other seven patients. The remaining two patients had midway lacerations which produced neither rupture nor aneurysmal formation. The midway LV lacerations are considered the result of LV incisions made at the time of mitral valve excision, generally in a setting where the left-sided cardiac chambers were only mildly dilated or normal and the tips of the blades of the scissors may have been inadequately visualized during mitral excision. This complication can be prevented by leaving the posterior mitral leaflet and its attached chordae intact or by applying exquisite care during the mitral excision procedure, or both. LV midway rupture may be most common cause of death early after MVR and operatively induced LV lacerations may lead to LV aneurysm late postoperatively.
D000328:Adult; D000368:Aged; D005260:Female; D006322:Heart Aneurysm / Q000209:etiology* / Q000473:pathology; D006352:Heart Ventricles / Q000293:injuries* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011182:Postoperative Care; D012421:Rupture; D013525:Surgical Instruments