Atrioventricular Groove Hematoma During Mitral Valve/Tricuspid Valve Repair

Kumar, Aseem; Fitzsimons, Brian; Trombetta, Carlos

doi:10.1213/ane.0b013e318284776f

Cited by 4 publications

(5 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Type I rupture occurs at the level of the AVG, which is the most common but most complex type and is also referred to as AVG disruption [5]. AVG disruption is typically accompanied by AVG hematoma, which is noticed on direct inspection by surgeons, occasionally as an early sign before frank rupture with massive bleeding and has a subsequent lethal clinical course [1, 6, 7].…”

Section: Discussionmentioning

confidence: 99%

“…AVG hematoma is usually detected at the termination of CPB when the heart starts beating again on its own [1, 6–8]. What is an acceptable upper size limit?…”

Section: Discussionmentioning

confidence: 99%

“…With intraoperative TEE [1, 7, 8], the surgeon’s subjective decision based only on their restricted inspection might be obsolete. Instead, reliable judgement from an objective perspective using a multidisciplinary approach seems necessary, especially in potentially unstable and unpredictable situations.…”

Section: Discussionmentioning

confidence: 99%

“…Atrioventricular groove (AVG) hematomas during mitral valve surgery range from simple hematomas to complex AVG disruptions that cause frank rupture with massive bleeding and subsequent mortality [1]. Kirklin’s textbook mentions that “a small or moderate-sized hematoma is present in the left AVG in 10% to 30% of all patients immediately after mitral valve replacement.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

To repair or not to repair: a case report of atrioventricular groove hematoma during mitral valve surgery

Nagamine

Date

Takagi

et al. 2019

J Cardiothorac Surg

View full text Add to dashboard Cite

BackgroundAtrioventricular groove hematomas during mitral valve surgery range from simple hematomas to complex atrioventricular disruptions that cause frank rupture with massive bleeding and subsequent mortality. A small or moderate-sized hematoma is reported to be present in the left atrioventricular groove in 10 to 30% of all patients immediately after mitral valve replacement. Despite the fact that atrioventricular groove hematomas are inherently unstable and unpredictable, conservative strategies are recommended due to the high mortality associated with additional surgical repair. Such conservative strategies, however, would not resolve the potential risk of rupture, and there also appears to be a certain degree of uncertainty to be overcome using the current advances in cardiac surgery.Case presentationWe present a case of atrioventricular hematoma during double valve replacement which was treated with conservative management. A left ventricular pseudoaneurysm developed after surgery, but spontaneously resolved completely within six months. After reflecting on our case, we developed a check sheet, including the anesthesiologist’s transesophageal echocardiography findings, for reasonable intraoperative decision-making regarding conservative management vs. additional surgical repair. Our check sheet helps organize the pathophysiological understanding of the injury and integrates partial findings from complementary viewpoints, and can be used to accurately assess intense situations and develop a common understanding among surgical team members.ConclusionsOur case involved an atrioventricular groove hematoma that occurred during mitral valve surgery and caused a left ventricular pseudoaneurysm. Conservative strategies yielded positive results. We hope our experience and original check sheet will be of value to surgical teams facing similar situations.

show abstract

Section: Discussionmentioning

confidence: 99%

“…AVG hematoma is usually detected at the termination of CPB when the heart starts beating again on its own [1, 6–8]. What is an acceptable upper size limit?…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

To repair or not to repair: a case report of atrioventricular groove hematoma during mitral valve surgery

Nagamine

Date

Takagi

et al. 2019

J Cardiothorac Surg

View full text Add to dashboard Cite

show abstract

“…Atrioventricular groove hematomas during mitral valve surgeries range from simple hematomas to complex atrioventricular groove disruptions that cause frank rupture with massive bleeding and subsequent mortality [103]. Kirklin's textbook mentions "a small or moderate-sized hematoma is present in the left atrioventricular groove in 10 percent to 30 percent of all patients immediately after MVR.…”

Section: Atrioventricular Groove Hematoma: To Repair or Not To Repairmentioning

confidence: 99%

A Treatise on The Surgical Management and A Suggested Amendment of Surgical Classification of Left Ventricular Rupture Following Mitral Valve Replacement

Gudala¹,

Chauhan²,

Jena³

et al. 2019

JICOA

View full text Add to dashboard Cite

The present perspective is a synthesis of 108 published investigations in the setting of different types of left ventricular rupture following mitral valve replacement (MVR). We identified 109 investigations and reviewed the clinical presentation, diagnostic modalities, surgical techniques and outcomes. Clinical presentation, roentgenography, cross-sectional transthoracic/transesophageal echocardiography and computerized tomography provided the diagnostic information and defined the causative mechanism. Magnetic resonance imaging had been used for further clarification of the native ventricular anatomy in high-risk subset of patients, undergoing non-traditional transapical off-pump mitral valve repair with neochordal implantation. In this article, we have attempted to address several concerning issues and controversies with reference to the possible causative mechanisms, preventive measures, the issue of chordal preservation during MVR, the degree of decalcification required in cases of heavily calcified mitral annulus, selection of appropriate sized prosthetic valves, the surgical importance of a small left ventricle, various techniques of repair, role of cardiopulmonary bypass and cardioplegic arrest during the repair of left ventricular rupture, the role of biodegradable epicardial tissue sealants, to repair or not to repair the atrio-ventricular groove hematoma during mitral valve surgery, and the role of intra-aortic balloon counterpulsation in the perioperative period. Additionally, we have highlighted a new type of left ventricular rupture described in the literature located between the base of the papillary muscle and the apex, which can be categorized as a complication of new technologies of mitral valve repair such as NeoChord device artificial chordal implantation. We have classified this category as type IV ventricular rupture. Overall, this review attempts to address the guidelines for different surgical approaches and techniques of repair of different types of left ventricular rupture for a successful outcome. We submit that an increased appreciation of the causative mechanisms of different types of left ventricular rupture and its prevention may well contribute to improved surgical management.

show abstract

Left atrial dissection: an almost unknown entity

Fukuhara

Dimitrova

Geller

et al. 2014

Interactive CardioVascular and Thoracic Surgery

123

View full text Add to dashboard Cite

Left atrial dissection is an exceedingly rare but potentially fatal complication of cardiac surgery. It is most commonly associated with mitral valve surgery, including both replacement and repair, with a reported incidence rate of 0.16%. However, other cardiac surgical or catheter-based interventional procedures are also known as potential predisposing factors. The time of presentation from the cause of dissection varies extremely, ranging from immediate occurrence up to 20 years later. The dissection forms a large cavity between the endocardium and epicardium of the left atrium, causing obliteration of the left atrial cavity and resultant haemodynamic compromise, which almost always requires immediate surgical intervention. In contrast, left atrial dissection without haemodynamic instability can often be managed non-operatively with satisfactory outcomes. This article reviews this rare but relevant clinical entity to further elucidate the incidence, pathogenesis, clinical course, management and outcome of left atrial dissection.

show abstract

Atrioventricular Groove Hematoma During Mitral Valve/Tricuspid Valve Repair

Cited by 4 publications

References 7 publications

To repair or not to repair: a case report of atrioventricular groove hematoma during mitral valve surgery

To repair or not to repair: a case report of atrioventricular groove hematoma during mitral valve surgery

A Treatise on The Surgical Management and A Suggested Amendment of Surgical Classification of Left Ventricular Rupture Following Mitral Valve Replacement

Left atrial dissection: an almost unknown entity

Contact Info

Product

Resources

About