Left ventricular rupture after mitral valve replacement: a report of 13 cases.
Left ventricular rupture after mitral valve replacement is a rare but lethal complication. Between 1995 and 2003, left ventricular rupture occurred in 13 of 5,449 patients who underwent mitral valve replacement, with an incidence of 0.24%. There were 4 immediate ruptures and 9 delayed ruptures. Urgent repair of the rupture was performed under cardiopulmonary bypass in 11 cases. All mitral prostheses were explanted. External repair alone was performed in one patient. External repair combined with internal repair was performed in 10 patients. Two patients died of cardiac tamponade and failure of cardiac resuscitation. Of the 11 patients who had a re-operation, 6 died in hospital and 5 survived. The mortality was 61.5% (8/13). At a mean follow-up of 4 years, 2 patients were in New York Heart Association functional class II and 3 were in class III. Proper diseased valve removal, decalcification, and prosthesis selection could minimize the incidence of left ventricular rupture. Immediate diagnosis and urgent surgical intervention are crucial for successful repair.
Zhang
Huai-Jun
HJ
Department of Adult Cardiac Surgery, Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Ma
Wei-Guo
WG
Xu
Jian-Ping
JP
Hu
Sheng-Shou
SS
Zhu
Xiao-Dong
XD
D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications; D001794:Blood Pressure; D005260:Female; D005500:Follow-Up Studies; D006335:Heart Injuries / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D006352:Heart Ventricles / Q000293:injuries; D006470:Hemorrhage / Q000150:complications; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D012421:Rupture; D016019:Survival Analysis