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A New Surgical Technique For Repair Of Left Ventricular Rupture After Mitral Valve Replacement
Harald Hausmann, Mohamed Ismail, Alaa Maali, Jan Schaarschmidt, Adrian Bauer.
Mediclin Herzzentrum Coswig, Coswig, Germany.

OBJECTIVE: Ventricular rupture (VR) after mitral valve replacement (MVR) is an infrequent but highly lethal complication. At present surgical results are not satisfactory.
METHODS: We operated on a 76 year old male with acute myocardial infarction (MI) by left main disease through a fresh thrombus formation. The patient was in hemodynamic unstable conditions when he reached the hospital. We performed two coronary bypass grafts and a MVR with a Hancock II bioprothesis. However, before ending cardiopulmonary bypass (CPB) a ventricular rupture at the posterior wall was noticed. Therefore, cardiac arrest was repeated and a 3 by 3 sqcm hematoma was identified. Bearing in mind, the patient is old, suffering from acute MI with low ejection fraction and VR after MVR is a highly lethal complication, we decided not to remove the valve but try to repair the ventricle from outside in the presence of the valve. We opened the left atrium again, three 2/0 prolene sutures with large teflon bledgets were used to repair the ventricle by mattress stiches passing the left ventricle from outside through the healthy tissue around the hematoma, ending in the sewing ring of the valve prothesis and tieing the sutures on the atrial side. The sewing ring offered ideal abutment for the sutures since the tissue around was very soft due to the MI.
RESULTS: Weaning from CPB went smoothly under support of low dose catecholmines. The patient was extubated after 17 hours and was discharged from hospital after 3 weeks. The echocardiography showed normal function of the valve prothesis, but reduced ventricular function due to the MI.
CONCLUSIONS: This new technique of VR repair after MVR can be performed very quickly and might be an option to improve the results in this severe complication especially in acute cases.

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