Abstract
Aortoventricular disruption after aortic valve replacement is extremely rare. A case of aortoventricular disruption following aortic valve replacement is described in detail, and related case reports are reviewed. A 76-year-old male underwent aortic valve replacement with a tissue valve using everting mattress sutures, repair of the ascending aortic aneurysm, and mitral valve repair. After cardiopulmonary bypass was terminated, pulsatile bleeding behind the aortic root was observed, which required cardiopulmonary bypass. The ventricular rupture was located just below the left coronary annulus, and appeared secondary to a tear through the ventricular myocardium by the valve sutures. The tear was internally repaired by pledgeted sutures and Dacron patch reinforcement. The patient recovered and was discharged without major complications. Although this serious complication is extremely rare, surgeons should be aware that deep everting stitches on the left coronary annulus potentially causes aortoventricular disruption. Overstretching the posterior aortoventricular junction may contribute to this type of injury.
Highlights
Left ventricular rupture is well documented as a critical complication of valve surgery, exclusively so in mitral valve replacement w1, 2x
We experienced a rare case of aortoventricular disruption after aortic valve replacement, which was successfully repaired by pledgeted sutures, and Dacron patch reinforcement, with re-implantation of the aortic prosthesis
Iida and coworkers w3x reported that the rupture occurred 6 h after the operation, and the cause of the rupture was an inadvertent injury to the left ventricular wall just below the left coronary annulus
Summary
Left ventricular rupture is well documented as a critical complication of valve surgery, exclusively so in mitral valve replacement w1, 2x. Aortoventricular disruption is extremely rare after valve surgery. We experienced a rare case of aortoventricular disruption after aortic valve replacement, which was successfully repaired by pledgeted sutures, and Dacron patch reinforcement, with re-implantation of the aortic prosthesis
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