| A Case of Mitral Valve Replacement
with Rupture of the Left Ventricle |
(Department of Cardiovascular Surgery, Jikei University
School of Medicine, Tokyo, Japan and Department of Surgery, Saku
Central Hospital*, Nagano, Japan)
| Yoshimasa Sakamoto |
Kazuhiro Hashimoto |
Hiroshi Okuyama |
| Kazuaki Shiratori* |
Motohiro Oshiumi |
Makoto Hanai |
| Takanori Inoue |
Gen Shinohara |
Shouhei Kimura |
| Takayuki Abe |
|
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|
A 56-year-old woman suffering from
mitral stenosis had underwent PTMC (percutaneous transvenous
mitral commissurotomy) at age 46. After she developed congestive
heart failure, mitral valve replacement (MVR) with Carbomedics
29M and tricuspid annuloplasty (TAP) was carried out. Four hours
after admission to the ICU, massive bleeding was noticed. Cardiopulmonary
bypass was restarted in the operating room. Laceration and hematoma
were found at the posterolateral wall of the left ventricle.
Under cardiac arrest with removal of the prosthetic valve, an
internal tear was detected about 2cm below the anterolateral
commissure (Miller Type III). The tear was covered with a horse
pericardial patch (2×3cm) using 6-0 running sutures with reinforcement
with gelatin-resorcine-formaline (GRF) glue between the laceration
and the patch. MVR sutures in the annulus above the ventricular
tear were first passed through the annulus, the pericardial patch
and then the prosthetic cuff. Additionally, an epicardial tear
was covered and reinforced with the fibrin sheet, GRF glue and
pericardial patch in turn. Cardiopulmonary bypass was weaned
easily without bleeding. The patient was intentionally on respiratory
support with sedation for 3 days. The subsequent postoperative
course was uneventful.
Jpn. J. Cardiovasc. Surg. 33: 391-394 (2004) |
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