title: Iatrogenic left ventricular-right atrial communication after tricuspid annuloplasty; a case report.
abstract: A 75-year-old man (Asian, Japanese) was readmitted for examination of a heart murmur and haemolytic anemia 3 months after mitral valve and tricuspid annuloplasties and coronary artery bypass. A new systolic murmur was heard, and echocardiography showed a high-velocity jet originating from the left ventricular outflow tract and extending to the right atrium, a small defect between the left ventricle and the right atrium. No periprosthetic leaks were found in the mitral position. We judged that surgical repair of the defect was essential to treat mechanical haemolysis. At operation, we found a communication (3 mm in diameter) just beneath the detached prosthetic ring at the anteroseptal commissure of the tricuspid valve. After partially removing the tricuspid ring from the anteroseptal commissure area, the defect was closed using a single mattress suture with pledget. In this case, the tricuspid annuloplasty stitch in the atrioventricular region was probably placed on the membranous septum rather than on the tricuspid annulus. A tear then occurred in the atrioventricular membranous septum, leading to left ventricular-right atrial communication.
authors.affiliation: Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-8563, Japan. e.tayama@kyumed.jp.
authors.forename: Eiki
authors.initials: E
authors.lastname: Tayama
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Tomita
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Imasaka
authors.forename: Takanori
authors.initials: T
authors.lastname: Kono
mesh_terms: D000368:Aged; D058385:Cardiac Valve Annuloplasty / Q000009:adverse effects*; D003937:Diagnosis, Differential; D017548:Echocardiography, Transesophageal; D005402:Fistula / Q000000981:diagnostic imaging / Q000209:etiology*; D006325:Heart Atria; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D006352:Heart Ventricles; D006801:Humans; D007049:Iatrogenic Disease; D007431:Intraoperative Complications; D008297:Male; D014262:Tricuspid Valve Insufficiency / Q000601:surgery*