Aortic Valve Leaflet Perforation after Mitral Valve Repair

Aboelnasr, Mohamed Sabry; Rohn, Vilém

doi:10.14712/23362936.2014.19

Cited by 6 publications

(5 citation statements)

References 11 publications

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“…Partial rings can potentially decrease the risk of aortic valve injury as the portion of the anterior annulus between both trigonal areas does not necessitate any stitch placement. In all previously reported articles, AR resulted from tethering of left or non-coronary leaflet due to an inadvertently placed suture preventing proper cusp mobility [ 2 , 4 , 6 , 7 , 13 ] or perforation of one of the three aortic leaflets tackled by an improperly orientated needle during its passage through the anterior mitral annulus [ 3 , 5 , 8 , 9 , 11 , 12 , 14 ]. The non-coronary leaflet is more likely to suffer from injury than the left and right coronary leaflets.…”

Section: Discussionmentioning

confidence: 99%

“…The non-coronary leaflet is more likely to suffer from injury than the left and right coronary leaflets. Out of the total 19 patients previously presented in the literature, 13 had injury of the non-coronary leaflet [ 2 , 3 , 8 , 9 , 11 – 13 ], 5 had that of the left coronary leaflet [ 3 – 7 ], and one had that of the right coronary leaflet [ 14 ]. In our case, the mechanism of progressive AR was probably due to the gradual increase of the non-coronary leaflet tear, as was previously described by Lakew et al in three patients who underwent minimally invasive MVR [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

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Iatrogenic non-coronary leaflet perforation as a complication after robotic mitral valve repair

Kalangos,

Zorman,

Güler

et al. 2024

J Cardiothorac Surg

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Iatrogenic aortic regurgitation secondary to leaflet injury is a rare complication of mitral valve surgery. For the first time, we report a patient who had progressive aortic regurgitation due to non-coronary leaflet perforation after robotic mitral valve repair and required aortic valve repair 18 months after this initial surgery. As in our case, aortic regurgitation after mitral valve surgery may remain undiagnosed on intraoperative transesophageal echocardiography or undetected until the patient’s discharge due to gradual enlargement of very small perforations over the postoperative course.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Iatrogenic non-coronary leaflet perforation as a complication after robotic mitral valve repair

Kalangos,

Zorman,

Güler

et al. 2024

J Cardiothorac Surg

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“…Aboelnasr and Rohn [ 4 ] reported a 32-year-old man with AV non-coronary cusp perforation resulting in severe AI after MV repair using a Carpentier-Edwards annuloplasty ring, which was repaired with pericardial patch. The postoperative course was reported to be uneventful.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Aortic Insufficiency Following Mitral Valve Replacement: Case Report and Review of the Literature

2015

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We report a 28-year-old white female who suffered significant aortic insufficiency (AI) following mitral valve (MV) replacement for endocarditis. The patient had history of rheumatoid arthritis and presented to our emergency department with a 3-month history of dyspnea, orthopnea, fevers and weight loss, worsening over 2 weeks, for which she took intermittent acetaminophen. On admission, vital signs revealed blood pressure of 99/70 mm Hg, heart rate of 120 beats/minute, and temperature of 98.8 °F; her weight was 100 lbs. Physical exam revealed a thin and pale female. Cardiac auscultation revealed regular tachycardic rhythm with a third heart sound, and a short early systolic murmur at the left lower sternal border without radiation. Lungs revealed right lower lobe rhonchi. Initial pertinent laboratory evaluation revealed hemoglobin 9.6 g/dL and white blood cell count 17,500/μL. Renal function was normal, and hepatic enzymes were mildly elevated. Chest radiogram revealed right lower lobe infiltrate. Blood cultures revealed Enterococcus faecalis. Two-dimensional echocardiogram revealed large multilobed vegetation attached to the anterior MV leaflet with severe mitral regurgitation (MR), otherwise normal left ventricular systolic function. She was started on appropriate antibiotics and underwent MV replacement with 25-mm On-X prosthesis. She was noted post-operatively to have prominent systolic and diastolic murmurs. Repeat echocardiogram revealed normal mitral prosthesis function, with new moderately severe AI. Transesophageal echocardiogram revealed AI originating from a tethered non-coronary cusp, due to a suture preventing proper cusp mobility. The patient declined further surgery. She recovered slowly and was discharged to inpatient rehabilitation 4 weeks later. This case highlights the importance of vigilance to this potential serious complication of valve surgery with regard to diagnosis and treatment to prevent long-term adverse consequences.

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“…Similarly, there are a few case reports on aortic valve perforation following mitral valve repair/replacement. [4][5][6] Injury to noncoronary cusp is the most common mechanism for aortic valve perforation during mitral valve surgery but may involve left coronary cusp also.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Mitral Valve Perforation following CABG and Aortic Valve Replacement: A Rare Complication detected by Post-bypass Transesophageal Echocardiography

Mathew¹,

Raj²

2014

Journal of Perioperative Echocardiography

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Iatrogenic mitral valve perforation following aortic valve replacement is a rare complication. We present a case of anterior mitral leaflet perforation following coronary artery bypass grafting (CABG) and aortic valve replacement detected by intraoperative transesophageal echocardiography (TEE). A 57-year-old male patient with preoperative diagnosis of coronary artery disease, sclerodegenerative aortic valve with severe aortic stenosis and mild central mitral regurgitation (MR) underwent CABG and aortic valve replacement. A post bypass TEE in midesophageal long axis view showed an additional MR jet across the body of the anterior mitral leaflet. We present intraoperative TEE images with a discussion on role of TEE in detection of mitral valve perforation and surgical decision making. Abbreviations AVR: Aortic valve replacement C ABG: Coronary artery bypass grafting 2D: Two-dimensional MR: Mitral regurgitation TEE: Transesophageal echocardiography TTE: Transthoracic echocardiography How to cite this article Raj R, Mathew S, Puri GD. Iatrogenic Mitral Valve Perforation following CABG and Aortic Valve Replacement: A Rare Complication detected by Post-bypass Transesophageal Echocardiography. J Perioper Echocardiogr 2014;2(2):75-76.

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Aortic Valve Leaflet Perforation after Mitral Valve Repair

Cited by 6 publications

References 11 publications

Iatrogenic non-coronary leaflet perforation as a complication after robotic mitral valve repair

Iatrogenic non-coronary leaflet perforation as a complication after robotic mitral valve repair

Iatrogenic Aortic Insufficiency Following Mitral Valve Replacement: Case Report and Review of the Literature

Iatrogenic Mitral Valve Perforation following CABG and Aortic Valve Replacement: A Rare Complication detected by Post-bypass Transesophageal Echocardiography

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