title: Aortoventricular disruption after aortic valve replacement: a rare complication.
abstract: Aortoventricular disruption after aortic valve replacement is extremely rare. A case of aortoventricular disruption following aortic valve replacement is described in detail, and related case reports are reviewed. A 76-year-old male underwent aortic valve replacement with a tissue valve using everting mattress sutures, repair of the ascending aortic aneurysm, and mitral valve repair. After cardiopulmonary bypass was terminated, pulsatile bleeding behind the aortic root was observed, which required cardiopulmonary bypass. The ventricular rupture was located just below the left coronary annulus, and appeared secondary to a tear through the ventricular myocardium by the valve sutures. The tear was internally repaired by pledgeted sutures and Dacron patch reinforcement. The patient recovered and was discharged without major complications. Although this serious complication is extremely rare, surgeons should be aware that deep everting stitches on the left coronary annulus potentially causes aortoventricular disruption. Overstretching the posterior aortoventricular junction may contribute to this type of injury.
authors.affiliation: Division of Cardiovascular Surgery, National Hospital Organization Kure Medical Center/Chugoku Cancer Center, 3-1 Aoyama-Cho, Kure 737-0023, Japan. teruyan@kure-nh.go.jp
authors.forename: Teruya
authors.initials: T
authors.lastname: Nakamura
authors.forename: Hironori
authors.initials: H
authors.lastname: Izutani
authors.forename: Takanori
authors.initials: T
authors.lastname: Shibukawa
authors.forename: Takuya
authors.initials: T
authors.lastname: Higuchi
mesh_terms: D000368:Aged; D001014:Aortic Aneurysm / Q000601:surgery; D001019:Aortic Rupture / Q000209:etiology* / Q000601:surgery; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D006341:Heart Rupture / Q000209:etiology* / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006352:Heart Ventricles / Q000293:injuries; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000601:surgery; D013536:Suture Techniques / Q000009:adverse effects; D018487:Ventricular Dysfunction, Left