| Left Ventricular Free Wall Rupture
Long-Term Development after Aortic Valve Replacement |
(Department of Cardiovascular Surgery, Fukui CardioVascular
Center, Fukui, Japan)
| Kenji Iino |
Hirokazu Ohashi |
Yasushi Tsutsumi |
| Takahiro Kawai |
Hiromichi Fujii |
Masateru Ohnaka |
|
In 1984, a 67-year-old man had aortic
valve replacement surgery for aortic regurgitation ; he returned
with chest pain on May 15, 2003. Emergency coronary angiography
was performed because electrocardiogram revealed ST segment depression
in leads V4 to V6. However, coronary angiography, echocardiogram
and chest computed tomography finding were normal. Therefore
the patient was discharged the following day. However, he was
re-admitted for chest pain, followed by loss of consciousness
4 days after his initial release. Echocardiogram and chest computed
tomography revealed perforation in the lateral wall of his left
ventricle (LV) and a "blow-out" type rupture was diagnosed. The
patient fell into cardiogenetic shock in the emergency room,
and emergency left ventricular free wall rupture (LVFWR) surgical
repair was performed under percutaneous cardiopulmonary support
(PCPS). A round perforation measuring about 10mm in diameter
was observed in the lateral LV wall along the course of LCx #12.
The perforation was closed using Teflon strip reinforced mattress
sutures. The hemostasis was reinforced with fibrin glue sheet
(TachoComb) and polyglygolic acid surgical mesh (Dexon Mesh),
with fibrin glue extensively applied. He was discharged on July
17, 2003 without major complications. In this case, the precise
cause that led to LVFWR was unknown. Emergency PCPS insertion
enabled the LVFWR surgical repair and extensive adhesion due
to the previous AVR prevented the massive bleeding to pericardial
cavity and the catastrophic hemodynamic deterioration : both
factors positively contributed to patient recovery.
Jpn. J. Cardiovasc. Surg. 33: 421-424 (2004) |
|
