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KMID : 0364019920250111254
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Korean Journal of Thoracic and Cardiovascular Surgery
1992 Volume.25 No. 11 p.1254 ~ p.1260
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Posterior Left Ventricular Wall Rupture after Mitral Valve Replacement
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Abstract
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Rupture of the posterior left ventricular wall following mitral valve replacement is a rare but fatal complication. Over a 10 year period from August 25 1980 to November 27 1990, we have experienced 6 such patients among 884 cases of mitral valve
replacement with 4 deaths and 2 survivors. One patient had a type I rupture and another a type II rapture with the remaining four patients having suffered type III ruptures. All of the ruptures were discovered intraoperatively enabling prompt
reinstitution of the cardiopulmonary bypass and subsequent cardioplegic arrest prior to repair.
Overzealous removal of calcified valve leaflets seemed to be responsible for the single type I rupture, and untethering of the so called ventricular loop appeared to the main mechanism responsible for the type III ruptures. The single type II
rupture
that had occurred seemed to have been caused by inadvertent laceration of the papillary muscle with resultant rupture of the posterior LV wall at the base of the papillary muscle. Among the type III ruptures, 2 patients required intraaortic
balloon
pump
(IABP) support only for mechanical assistance and 1 patient required both the IABP and the Biomedicus LV assist device for successfull weaning following repair of the LV rupture. Another patient with a type II rupture also required the
circulatory
assistance of both the IABP and the biomedicus LV assist device for weaning from the bypass. Attention to meticulous technical considerations such as avoiding over aggressive removal of heavily calcified valvular tissue, preservation of as much
mural
leaflet tissue and chordal stuctures as possible seemed helpful in preventing this catastrophic complication from occuning Fusion and fibrous stricture of the chordal structures appeared particularly conducive to the type II ruptures as a result
of
the
increased susceptibility to papillary injury during operation.
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KEYWORD
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