title: Iatrogenic ventricular septal defect: A rare complication of surgical reconstruction of mitral paravalvular dehiscence.
abstract: BACKGROUND
  Iatrogenic ventricular septal defect is a rare complication after the surgical replacement of cardiac valves. Small defects may have no hemodynamic significance or remain unremarked at the end of the surgical procedure. Understanding of the valvular anatomy alone is not always enough to avoid such complications, especially in the hands of young surgeons.
  
  
  METHODS
  We present a case of iatrogenic ventricular septal defect that developed early after the surgical closure of a hemodynamically significant mitral paravalvular leak. Although the patient's critical state did not allow surgical intervention and he died, we think the lessons drawn from this case could be helpful to avoid such horrible complications in the future.
  
  
  CONCLUSIONS
  This case documents a rare disastrous complication after imperfect surgical closure of a mitral paravalvular leak. Despite the unfortunate end, in reporting this case we try to direct the light to the possible mechanisms that led to the development of this injury focusing on the embryological and anatomical background.
  
  
  CONCLUSIONS
  Understanding the anatomical and embryological structure of the cardiac fibrotic skeleton should keep cardiac surgeons more vigilent in detecting iatrogenic ventricle septal defects before the development of a devastating hemodynamic state.
authors: Department of Cardiac Surgery, Zala County Saint Rafael Hospital, Zalaegerszeg, Hungary. Electronic address: aref.rashed.szv@zmkorhaz.hu.
authors: Aref
authors: A
authors: Rashed
authors: Department of Cardiac Surgery, Zala County Saint Rafael Hospital, Zalaegerszeg, Hungary.
authors: Karoly
authors: K
authors: Gombocz
authors: Department of Cardiac Surgery, Zala County Saint Rafael Hospital, Zalaegerszeg, Hungary.
authors: Janos
authors: J
authors: Fulop
authors: Department of Cardiac Surgery, Zala County Saint Rafael Hospital, Zalaegerszeg, Hungary.
authors: Nasri
authors: N
authors: Alotti
keywords: Cardiac fibrotic skeleton; Case report; Iatrogenic ventricle septal defect; Paravalvular leak