Repair of injured right inferior pulmonary vein during mitral valve replacement

Efstratios Apostolakis,Vassilios N Leivaditis,Antonios Kallikourdis,Panagiotis Dedeilias

doi:10.1186/1749-8090-4-64

Abstract

During mitral valve surgery right pulmonary veins injury, subsequent to excessive traction (for better exposure of the mitral apparatus), is often unavoidable. This is more likely in patients with small left atrium. This common complication may cause severe intraoperative bleeding, while its surgical repair may lead to complications such as late stenosis or obstruction of the pulmonary veins. This injury should be early detected, before left atriotomy closing, and it is suggested to be repaired using a patch so as to avoid any possible late constriction.We describe a case -to our knowledge, the first reported in the literature- of intraoperatively injured right inferior pulmonary vein in a patient who underwent mitral valve replacement. As outlined we propose that the ostium of the right inferior pulmonary vein can be repaired by using autologous pericardial patch, incorporated in the completion of left atriotomy closure.

Highlights

The exposure of mitral valve during its repair or replacement is usually obtained through the Sondergaard's groove method
As outlined we propose that the ostium of the right inferior pulmonary vein can be repaired by using autologous pericardial patch, incorporated in the completion of left atriotomy closure
LFeigftuAretri1um rupture is extended to the lateral wall of the right inferior pulmonary vein Left Atrium rupture is extended to the lateral wall of the right inferior pulmonary vein

Summary

Introduction

The exposure of mitral valve during its repair or replacement is usually obtained through the Sondergaard's groove method. After completion of the replacement and during the atriotomy closure it was realized that the atriotomy was extended due to the retraction for better exposure of the valve, with subsequent injury to a) the RIPV, b) interatrial septum and c) posterior wall of the left atrium. Despite efforts to control the bleeding and repair the vein by adding interrupted sutures, the rupture was extended distally towards to the hilum of the right lung and the vein's outlet to the atrium was significantly stenosed. A small autologous pericardial patch (2 × 3 cm) was excised and used for the repair starting from the distal posterior part of the rupture close to the right lung's hilum and ending in the proximal part of the vein's outlet in the left atrium [Figure 2].

Discussion

Conclusion