ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Management of left ventricular rupture following mitral valve replacement
Cüneyt Narin 1, Hasan Reyhanoğlu 2, İsa Durmaz2
1Selçuk Üniversitesi Meram Tıp Fakültesi Kalp ve Damar Cerrahisi Anabilim Dalı, Konya
2Ege Sağlık Hastanesi Kalp ve Damar Cerrahisi Kliniği, İzmir
Background: Left ventricular rupture (LVR) is one of the most severe complications following mitral valve replacement (MVR). In this study, we evaluated patients who developed LVR after MVR within a four-year period.

Methods: Between May 2000 and 2004, a total of 218 patients underwent MVR. Of these, LVR developed in four patients (4 females; mean age 53±8 years) in the early (n=2) and late (n=2) postoperative period. Surgical repair was performed in three patients who had type I ruptures. Repair was not possible in one patient due to insufficiency of time. Surgical repair was commenced with reinstitution of cardiopulmonary bypass (CPB) and induced heart arrest. The left atrium was reopened and the prosthesis was removed. During repair, Teflon felt strips were used on the ventricular and atrial sides and the rupture was closed by interrupted horizontal mattress sutures. After the repair procedure, mitral prosthesis was replaced with one of a smaller size.

Results: In three patients who underwent a repair operation, the main pathology was rheumatic mitral valve stenosis, and only MVR was performed. The remaining patient underwent MVR without repair, as well as aortic valve replacement, and left atrial thrombectomy due to recurrent mitral stenosis, mitral and aortic regurgitation, and left atrial thrombus after a previous open mitral commissurotomy. Following surgical repair, two patients were discharged without any sign of cardiac failure. The remaining two patients died.

Conclusion: During mitral valve replacement, preservation of the posterior leaflet of the mitral valve, avoidance of deeply placed myocardial sutures, minimal traction of the mitral valve annulus, and avoidance of undue manipulation of the heart during de-airing are important measures to prevent LVR. Repair for LVR should be accomplished with the aid of CPB on the arrested heart.

Keywords : Heart rupture/surgery; heart valve prosthesis implantation; heart ventricles; mitral valve/surgery; postoperative complications/ surgery; rupture, spontaneous
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