Left Ventricular Pseudoaneurysm Repair after Mitral Valve Re-replacement for Prosthetic Valve Endocarditis

Daisuke Yano＊	Fumiaki Kuwabara＊	Shinji Yamada＊
Shinichi Ashida＊	Yuichi Hirate＊

（Cardiovascular Surgery, Nagoya Ekisaikai Hospital＊, Nagoya, Japan）

A 69-year-old woman with a medical history of mitral valve replacement for infective endocarditis 14 years previously was recently admitted after being given a diagnosis with multiple cerebral infarction along with headache and speech disturbance. After emergency admission, both transthoracic and transesophageal echocardiographies revealed multiple, extensive vegetation on the mitral prosthetic valve. Based on these findings, we diagnosed prosthetic valve endocarditis with cerebral septic embolization;and immediate mitral valve re-replacement surgery was performed. During the operation, a complication occurred when the left ventricular posterior wall ruptured during withdrawal from the cardiopulmonary bypass after mitral valve re-replacement. After a second cross-clamp and resection of the mitral prosthetic valve, we repaired the myocardial laceration and repeated the mitral valve re-replacement. We selected the following two methods from different approaches to repair the left ventricular rupture:(ａ) exclusion of the myocardial laceration using a bovine pericardial patch（intracardiac approach）;and (ｂ) direct suturing of the bleeding epicardium（extracardiac approach). Seven days after the surgery, computed tomography（CT）revealed a pseudoaneurysm in the left ventricular posterior wall. Several follow-up examinations using CT and echocardiography revealed gradual enlargement of the pseudoaneurysm. At 112 days after previous surgery, we successfully repaired the pseudoaneurysm through left lateral thoracotomy using the femorofemoral bypass with hypothermia. In the final surgery, we closed the orifice of the pseudoaneurysm using bovine pericardium. This case highlighted that left thoracotomy using a femorofemoral bypass with hypothermia could be a useful approach to address a left ventricular posterior wall pseudoaneurysm.

 

Jpn. J. Cardiovasc. Surg. 47:166-169（2018）

Keywords：left ventricular pseudoaneurysm;left ventricular rupture;prosthetic valve endocarditis;mitral valve re-replacement;patch closure