title: Use of a sandwich technique to repair a left ventricular rupture after mitral valve replacement.
abstract: One difficulty with external repair of left ventricular rupture after mitral valve replacement is collateral bleeding in friable myocardium adjacent to the rupture. The bleeding is caused by tension on the closing sutures, whether or not pledgets have been used. We report the case of a 69-year-old woman who underwent an uneventful mitral valve replacement. After cardiopulmonary bypass was terminated, brisk bleeding started from high in the posterior left ventricular wall, typical of a type III defect. We undertook external repair, placing a plug of Teflon felt into the cavity of the rupture and sandwiching it into place with pledgeted mattress and figure-of-8 sutures. The space occupied by the plug decreased the distance needed to obliterate the defect and thereby reduced the tension on the sutures necessary to achieve hemostasis. This simple technique enabled closure of the defect and avoided collateral tears that would have compromised an otherwise successful repair. Two years postoperatively, the patient had normal mitral valve function and no left ventricular aneurysm. In addition to reporting the patient's case, we review the types of left ventricular rupture that can occur during mitral valve replacement and discuss the various repair options.
authors.affiliation: Department of Cardiothoracic Surgery (Drs. A. Lee and M. Lee), St. Francis Medical Center, Lynwood, California 90262; and pre-medical student (Ms Tamboli), Washington University, St. Louis, Missouri 63130.
authors.forename: Myles E
authors.initials: ME
authors.lastname: Lee
authors.affiliation: Department of Cardiothoracic Surgery (Drs. A. Lee and M. Lee), St. Francis Medical Center, Lynwood, California 90262; and pre-medical student (Ms Tamboli), Washington University, St. Louis, Missouri 63130.
authors.forename: Mallika
authors.initials: M
authors.lastname: Tamboli
authors.affiliation: Department of Cardiothoracic Surgery (Drs. A. Lee and M. Lee), St. Francis Medical Center, Lynwood, California 90262; and pre-medical student (Ms Tamboli), Washington University, St. Louis, Missouri 63130.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Lee
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass / Q000379:methods; D005260:Female; D006322:Heart Aneurysm / Q000209:etiology / Q000517:prevention & control*; D006341:Heart Rupture / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006352:Heart Ventricles / Q000293:injuries / Q000601:surgery; D006488:Hemostasis, Surgical / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000503:physiopathology; D008943:Mitral Valve / Q000601:surgery; D008946:Mitral Valve Stenosis / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control*; D012214:Rheumatic Heart Disease / Q000601:surgery; D013536:Suture Techniques; D016896:Treatment Outcome
keywords: Cardiac surgical procedures/adverse effects; heart rupture/etiology; heart valve prosthesis implantation/adverse effects; heart ventricles/injuries/surgery; mitral valve insufficiency/surgery; surgical techniques; treatment outcome