Rupture of left ventricle after mitral valve repair: case report and new technique of repair.

Izzat, Mohammad Bashar; Smith, Geoffrey

doi:10.1136/hrt.69.4.366

Cited by 17 publications

(15 citation statements)

References 9 publications

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“…Surgical repair of the rupture with and without CPB resulted in 50% and 7% survival, respectively. With the use of CPB, external repair was followed by a 67% survival and the internal approach, by a 27% survival [9,87]. Despite early treatment, Bjork and associates have reported a mortality rate of 50% in patients presenting with early rupture.…”

Section: Resultsmentioning

confidence: 99%

“…Smith in 1993 used posterior mitral leaflet as a buttressing material for repair of type I left ventricular rupture [87]. Advantages of this technique includes i) avoidance of injury to the circumflex arterial system, ii) maintenance of the "tethered loop" of the left ventricle and iii) achievement of complete closure of the defect.…”

Section: Use Of Posterior Mitral Leaflet As a Buttressing Material: Imentioning

confidence: 99%

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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

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Use Of Posterior Mitral Leaflet As a Buttressing Material: Imentioning

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

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“…External repair can be used in type II and type III repairs. 8,9 Our external repair involved the use of deep pledgeted horizontal mattress sutures that passed through-and held in place-pieces of Teflon placed within the defect. Additional figure-of-8 sutures were passed more superficially through the plug, to prevent its migration into the LV cavity.…”

Section: Discussionmentioning

confidence: 99%

Use of a Sandwich Technique to Repair a Left Ventricular Rupture after Mitral Valve Replacement

Lee

Tamboli

Lee³

2014

Texas Heart Institute Journal

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One difficulty with external repair of left ventricular rupture after mitral valve replacement is collateral bleeding in friable myocardium adjacent to the rupture. The bleeding is caused by tension on the closing sutures, whether or not pledgets have been used. We report the case of a 69-year-old woman who underwent an uneventful mitral valve replacement. After cardiopulmonary bypass was terminated, brisk bleeding started from high in the posterior left ventricular wall, typical of a type III defect. We undertook external repair, placing a plug of Teflon felt into the cavity of the rupture and sandwiching it into place with pledgeted mattress and figure-of-8 sutures. The space occupied by the plug decreased the distance needed to obliterate the defect and thereby reduced the tension on the sutures necessary to achieve hemostasis. This simple technique enabled closure of the defect and avoided collateral tears that would have compromised an otherwise successful repair. Two years postoperatively, the patient had normal mitral valve function and no left ventricular aneurysm. In addition to reporting the patient's case, we review the types of left ventricular rupture that can occur during mitral valve replacement and discuss the various repair options.

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“…[ 2 3 4 ] Rapid exsanguinating hemorrhage results in high mortality which varies between 50% and 93% with or without the use of cardiopulmonary bypass (CPB). [ 5 ] Hence, insights into its prevention and management are important. In this case report, we share and discuss our experience of a repair of posterior LV rupture following MVR for rheumatic severe calcific mitral stenosis (MS).…”

Section: Introductionmentioning

confidence: 99%

Left ventricular rupture postmitral valve replacement: Surviving a catastrophe

et al. 2015

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One of the dreaded mechanical complications of mitral valve replacement (MVR) is rupture of the left ventricle (LV). This report describes the early diagnosis and successful repair of rupture of posterior wall of LV in an elderly patient who underwent MVR. We have discussed the risk factors and perioperative issues implicated in such complication. The anesthesiologist as an intra-operative echocardiographer can aid in identifying the patient at risk. Though important surgical steps are necessary to prevent the complication; nonetheless, the anesthesiologist needs to take key measures in the perioperative period.

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Rupture of left ventricle after mitral valve repair: case report and new technique of repair.

Abstract: Type 1 rupture of the left ventricle occurred during mitral valve repair. A repair operation, in which the posterior leaflet of the mitral valve was used as a buttress, was successful.

Cited by 17 publications

References 9 publications

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

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

Use of a Sandwich Technique to Repair a Left Ventricular Rupture after Mitral Valve Replacement

Left ventricular rupture postmitral valve replacement: Surviving a catastrophe

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