title: Mitral valve periprosthetic leakage: Anatomical observations in 135 patients from a multicentre study.
abstract: OBJECTIVE
  Prosthetic valve dysfunction after mitral valve replacement (MVR) may be caused by several factors, which often lead to repeated surgery. One of the most frequent determinants of reoperation is periprosthetic leakage (PPL). A few published reports have analysed PPL incidence and postoperative results after MVR, but no specific attention has been paid towards the potential relation between anatomical factors and PPL occurrence, particularly not bacterial-related. The aim of this study was to evaluate the location of PPL after MVR through a multicentre retrospective study.
  
  
  METHODS
  Between January 1985 and November 2005, 135 patients underwent reoperation at four institutions because of PPL after MVR and met the study inclusion criteria. The mitral valve annulus (MVA) was analysed in a clockwise format, indicating 12 o'clock as the mid-point of anterior annulus as viewed from the atrium.
  
  
  RESULTS
  Overall hospital mortality was 3.7% (five patients). Repair of PPL was carried out in 83 cases whereas prosthetic valve replacement was necessary in 52 cases. The total number of sectors involved in PPL was 244. PPL occurred more frequently between hour 5 and hour 6, and hour 10 and hour 11, with the risk of leakage being, 2.8 and 2.0 times higher, respectively, than in any other portion of the MVA.
  
  
  CONCLUSIONS
  Our study suggests that PPL occurs more frequently at antero-lateral and postero-medial segments of MVA. This finding might be linked to unusual anatomical and functional factors of the MVA and may call for adjunctive care to these sectors of MVA when performing suture placement during MVR.
authors.affiliation: Cardiac Surgery Unit, Civic Hospital, Brescia, Italy. giudeci@libero.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Cicco
authors.forename: Claudio
authors.initials: C
authors.lastname: Russo
authors.forename: Antonella
authors.initials: A
authors.lastname: Moreo
authors.forename: Cesare
authors.initials: C
authors.lastname: Beghi
authors.forename: Carlo
authors.initials: C
authors.lastname: Fucci
authors.forename: Piersilvio
authors.initials: P
authors.lastname: Gerometta
authors.forename: Roberto
authors.initials: R
authors.lastname: Lorusso
mesh_terms: D000368:Aged; D001705:Bioprosthesis; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies