Left Ventricular Rupture after Mitral Valve Replacement.

Kouichi Hisatomi; Tadashi Isomura; Nobuhiko Hayashida; Akio Hirano; Shyuji Fukunaga; Tohru Sato; Masaru Nishimi; Shigeaki Aoyagi; Kenichi Kosuga; Kiroku Ohishi

doi:10.4326/jjcvs.21.419

January 1, 1992Japanese Journal of Cardiovascular SurgeryOpen Access

Left Ventricular Rupture after Mitral Valve Replacement.

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Why the study?

What are the clinical characteristics, contributing factors, and outcomes of left ventricular rupture after mitral valve replacement?

Key Points

To investigate the clinical characteristics, anatomical sites, and causative mechanisms of left ventricular rupture following mitral valve replacement to identify preventive measures.
Retrospective review of 8 patients (1 male, 7 females; mean age 58 years, range 43–67) who developed left ventricular rupture among 1,046 mitral valve replacements performed between September 1965 and August 1991.
Categorized rupture location using the Treasure and Miller classification (5 type I, 2 type II, 1 type III) and evaluated timing of rupture alongside surgical repair techniques.
Rupture onset occurred during cardiopulmonary bypass weaning in 3 cases, during chest closure in 1 case, and postoperatively at 11, 14, 18, and 25 hours in 1 case each.
Surgical repair achieved initial hemostasis in only 2 of 8 patients (both occurring immediately after bypass weaning and repaired under cardioplegic arrest), but both died on postoperative days 2 and 44 from low cardiac output syndrome and multiorgan failure.
Delayed ruptures were triggered by sudden elevations in arterial blood pressure and were histologically characterized by extensive cardiomyocyte degeneration, loss, and myocardial fragility.

Structured PICO

What are the clinical characteristics, contributing factors, and outcomes of left ventricular rupture after mitral valve replacement?

P

Population

8 patients who developed left ventricular rupture during or after mitral valve replacement (out of a cohort of 1,046 MVR patients), mean age 58 years, 7 females and 1 male.

I

Intervention

Surgical repair of left ventricular rupture (3 on beating heart from epicardial side, 5 under cardiac arrest from endocardial side).

O

Outcome

Hemostasis and survival after surgical repair of left ventricular rupture.hard clinical

Left ventricular rupture after mitral valve replacement carries an extremely high mortality rate, highlighting the critical need to avoid sudden arterial pressure elevations in the acute postoperative phase.

Implication

LV rupture after MVR carries near-total mortality despite attempted repair; leaves open targeted prevention of postoperative hypertensive surges in fragile myocardium.

Abstract

僧帽弁置換術後の左室破裂は, とくに遅発例に関して救命率も低く, 発生要因の解明および防止法の確立が急務である. 今回われわれは1965年9月より1991年8月までに, 当科において僧帽弁置換術を施行した1046例中, 術中および術後に左室破裂をきたした8例を対象に, その発生要因の検討を行った. 年齢は43歳から67歳 (平均58歳), 男性1例, 女性7例で, 破裂部位 (Treasure, Miller らの分類) は type I 5例, type II 2例, type III 1例, 左室破裂発症時期は, 体外循環離脱時3例, 閉胸時1例,術後11時間, 14時間, 18時間, 25時間のおのおの1例であった. 8例中3例は心拍動下に左室外側より修復, 5例は体外循環下に心停止を行い, 左室内腔より破裂部を修復した. しかし体外循環離脱直後に発生し, 心停止下に修復を行った2例 (おのおの低心拍出量症候群, 多臓器不全にて術後2日目, 44日目に死亡した) 以外は, 修復後もまったく止血不能であった. われわれはとくに最近の遅発例で, 血圧の上昇後に突然発生したこと, 組識学的にも心筋細胞の脱落, 変性を広範囲に認め, 心筋の脆弱性が認められたことから, 術後急性期の動脈圧の急激な上昇を避ける管理は, 発生防止の有効な方法となるものと考えている.

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Cite This Study

Hisatomi et al. (1992) studied this question.

synapsesocial.com/papers/6a707bcfe36a167817e245af https://doi.org/10.4326/jjcvs.21.419

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Left Ventricular Rupture after Mitral Valve Replacement.

Key Points

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Left Ventricular Rupture after Mitral Valve Replacement.

Key Points

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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