| Surgical Management of Perivalvular Leakage after Mitral Valve Replacement |
(Department of Cardiac Surgery, Jikei University School of Medicine, Tokyo, Japan)
| Yoshimasa Sakamoto |
Kazuhiro Hashimoto |
Hiroshi Okuyama |
| Shinichi Ishii |
Shingo Taguchi |
Takahiro Inoue |
| Hiroshi Kagawa |
Kazuhiro Yamamoto |
Kiyozo Morita |
| Ryuichi Nagahori |
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Perivalvular leakage (PVL) is one of the serious complications of mitral valve replacement. Between 1991 and 2006, 9 patients with mitral PVL underwent reoperation. All of them had severe hemolytic anemia before surgery. The serum lactate dehydrogenase (LDH) level decreased from 2,366±780 IU/l to 599±426 IU/l after surgery. The site of PVL was accurately defined in 7 patients by echocardiography. PVL occurred around the posterior annulus in 3 patients, anterior annulus in 2, anterolateral commissure in 1, and posteromedial commissure in 1. The most frequent cause of PVL was annular calcification in 5 patients. Infection was only noted in 1 patient. In 4 patients, the prosthesis was replaced, while the leak was repaired in 5 patients. There was one operative death, due to multiple organ failure, and 4 late deaths. The cause of late death was cerebral infarction in 1 patient, subarachnoid hemorrhage in 1, sudden death in 1, and congestive heart failure (due to persistent PVL) in 1. Reoperation for PVL due to extensive annular calcification is associated with a high mortality rate and high recurrence rate, making this procedure both challenging and frustrating for surgeons.
Jpn. J. Cardiovasc. Surg. 37: 13-16 (2008) |
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