[Left ventricular rupture following mitral valve replacement].
Left ventricular rupture following mitral valve replacement is an unusual but highly lethal complication. Between 1982 and 2004, 254 patients underwent mitral valve replacement with coronary artery bypass grafting (CABG) [7 patients], aortic or tricuspid valve operation or both (84 patients), or without concomitant operation (163 patients). There were 11 hospital deaths (4.3%) and 4 left ventricular ruptures (1.6%). No concomitant operation had been performed in all rupture cases. Type I rupture occurred in 2 patients with complete resection of the mitral valve, and type III in the others with preservation of the posterior leaflet or basal chordae. Three of 4 were early and 1 was delayed rupture. The cause of rupture was obvious in 2 patients, over-excision of the posterior mitral annulus (type I) and impingement of the strut (type III). Intra-cardiac, extra-cardiac or both combined surgical repair was attempted under the cardioplegic arrest for all patients, however, 2 of 4 patients died for postoperative low cardiac output syndrome (LOS) and intra-operative bleeding. Techniques of repair and prevention of rupture are discussed.
Kunitomo
Ryuji
R
Department of Cardiovascular Surgery, Kumamoto University School of Medicine, Kumamoto, Japan.
Kawasuji
Michio
M
D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D011183:Postoperative Complications; D018658:Ventricular Septal Rupture / Q000517:prevention & control / Q000601:surgery*