Repair Of Left Ventricular Rupture Research Articles

Double-patch repair of left ventricular rupture after mitral valve replacement

Cardiovascular Surgery and Interventions publishes original articles on topics in cardiovascular surgery, cardiovascular anesthesia and cardiology. These encompass all relevant clinical, surgical and laboratory studies, editorials, current and collective reviews, technical know-how papers, case reports, interesting images, “How to Do It” papers, correspondence and commentary.

A Treatise on The Surgical Management and A Suggested Amendment of Surgical Classification of Left Ventricular Rupture Following Mitral Valve Replacement

The present perspective is a synthesis of 108 published investigations in the setting of different types of left ventricular rupture following mitral valve replacement (MVR). We identified 109 investigations and reviewed the clinical presentation, diagnostic modalities, surgical techniques and outcomes. Clinical presentation, roentgenography, cross-sectional transthoracic/transesophageal echocardiography and computerized tomography provided the diagnostic information and defined the causative mechanism. Magnetic resonance imaging had been used for further clarification of the native ventricular anatomy in high-risk subset of patients, undergoing non-traditional transapical off-pump mitral valve repair with neochordal implantation. In this article, we have attempted to address several concerning issues and controversies with reference to the possible causative mechanisms, preventive measures, the issue of chordal preservation during MVR, the degree of decalcification required in cases of heavily calcified mitral annulus, selection of appropriate sized prosthetic valves, the surgical importance of a small left ventricle, various techniques of repair, role of cardiopulmonary bypass and cardioplegic arrest during the repair of left ventricular rupture, the role of biodegradable epicardial tissue sealants, to repair or not to repair the atrio-ventricular groove hematoma during mitral valve surgery, and the role of intra-aortic balloon counterpulsation in the perioperative period. Additionally, we have highlighted a new type of left ventricular rupture described in the literature located between the base of the papillary muscle and the apex, which can be categorized as a complication of new technologies of mitral valve repair such as NeoChord device artificial chordal implantation. We have classified this category as type IV ventricular rupture. Overall, this review attempts to address the guidelines for different surgical approaches and techniques of repair of different types of left ventricular rupture for a successful outcome. We submit that an increased appreciation of the causative mechanisms of different types of left ventricular rupture and its prevention may well contribute to improved surgical management.

Off-pump suture repair of left ventricular rupture utilizing TachoComb® sheet: a case report and literature review

A 70-year-old woman was admitted to our institution with acute myocardial infarction. Coronary angiography demonstrated total occlusion of the left anterior descending artery, which was successfully revascularized. Four days later, the patient suddenly went into shock. The subsequent emergency operation revealed a blowout rupture of the left ventricular free wall. Several TachoComb® (CSL Behring, Tokyo, Japan) sheets were applied to control bleeding and avoid the need for a cardiopulmonary bypass. Horizontal mattress sutures were used in combination with a pair of Teflon felt strips for reinforcement. The combination of TachoComb® sheets and sutures is a novel hybrid method and an effective life-saving procedure for the treatment of left ventricular blowout ruptures. This approach avoids the need for a cardiopulmonary bypass. Sutureless repairs with TachoComb® sheet achieve rapid hemostasis without the need for cardiopulmonary bypass. This stabilizes patient hemodynamics immediately and preserves the fragile myocardium. This allows emergency room physicians to open the chest and apply the TachoComb® sheet to stabilize the patient before the cardiac surgeons arrive at the operating room. This technique will be very useful in emergency situations.

Off pump repair of left ventricular rupture following mitral valve replacement: The crucial assistance of the IntraAortic Balloon Pump

INTRODUCTIONLeft ventricular (LV) rupture is a not as frequent, but potentially lethal complication of mitral valve replacement or repair. PRESENTATION OF CASEWe report a case of a 67-year-old man who underwent mitral valve replacement and Cox Maze IV procedure. A massive bleed from the LV rupture was noted postoperatively while the patient was extubated. The control of bleeding was impossible until an IntraAortic Balloon Pump (IABP) was inserted. A bovine pericardial patch was applied, overlapping an extensive epicardial area, perimetrically of the hematoma. Between the epicardium and the pericardial patch we applied an autologous fibrin sealant. DISCUSSIONThe off-pump technique used to repair the LV rupture after a MVR, is more feasible when the patient is supported by an IABP that subsequently decreases the tension of the myocardial suture site. CONCLUSIONThe IABP, is a necessary device, that decreases the tension along the suture site post a left ventricular rupture following a MVR.

<![CDATA[<B>Surgical repair of left ventricular rupture after the use of tenecteplase in the treatment of acute myocardium infarction</B>]]>

<![CDATA[<B>Surgical repair of left ventricular rupture after the use of tenecteplase in the treatment of acute myocardium infarction</B>]]>

左室前側壁に仮性左室りゅうを生じた僧帽弁置換術後左室破裂の１例

僧帽弁置換術に伴う左室破裂修復後の仮性左室瘤形成はまれであるが,その破裂部位,瘤形成部位が従来の報告とは異なった症例を経験したので報告する.症例は32歳男性.僧帽弁閉鎖不全症に対し胸骨下部T字状部分切開にて弁置換術施行.集中治療室2時間後に左室側壁破裂をきたし,心停止下にフェルト補強下に破裂部を縫合したのち,心膜パッチにて被覆逢着した.術後の胸部CT,左室造影にて左室前側壁に左冠動脈に沿って仮性左室瘤を認め,瘤形成部位から判断するに左室破裂は前交連付近の弁輪部から生じたものと推察された.胸骨下部部分切開,経心房アプローチによるためか,胸骨正中切開に比較し前交連付近視野が不良であり,弁切除や糸掛けのさいに心筋を損傷した可能性が考えられた.現在のところ左室瘤に起因すると思われる症状は認められておらず,外来にて厳重に経過観察する方針である.

Autotransplantation of heart for repair of left ventricular rupture after mitral valve replacement

Autotransplantation of heart for repair of left ventricular rupture after mitral valve replacement

CT diagnosis of cardiac and pericardial injuries

The purpose of this retrospective study was to determine the CT findings diagnostic of cardiac and pericardial injury, including signs of pericardial tamponade, in patients suffering from blunt and penetrating trauma. A search of the CT radiology database at a level I trauma center was performed to identify cases in which injury to the heart or pericardium was diagnosed, as well as to identify cases of pericardial tamponade. All cases were reviewed to ascertain the specific CT findings, and medical records were reviewed to assess the influence of CT findings on management and to assess for clinical evidence of pericardial tamponade. Eighteen patients had direct CT evidence of cardiac or pericardial injury, including nine cases of pneumopericardium, eight cases of hemopericardium, and one case of intrapericardial gastric herniation. Four of these patients were found to have direct cardiac injuries. Three additional cases with CT evidence of pericardial tamponade were identified, two secondary to cardiac compression by an anterior mediastinal hematoma and one following repair of left ventricular rupture. Of 11 patients with CT evidence of tamponade, only three were suspected clinically. Cardiac and pericardial injuries are usually diagnosed surgically and are often clinically unsuspected, particularly in blunt trauma. As CT is increasingly utilized as a general screening test for thoracic/abdominal trauma, these injuries may be first suspected on the basis of CT findings, and knowledge of the CT findings of cardiac injury or tamponade is crucial.

Repair of left ventricular rupture after mitral valve replacement: use of a Teflon patch and glue

Rupture of the left ventricular wall is an infrequent but lethal complication after mitral valve replacement. We present the case of a patient in whom such a rupture was successfully repaired in the intensive care unit with a patch of Teflon felt stuck in place with glue.

Successful invasive management and surgical repair of subacute ventricular rupture complicating myocardial infarction.

We describe a patient following acute myocardial infarction with a protracted clinical course presenting transient episodes of hypotension, who eventually developed cardiac tamponade. Echocardiography demonstrated pericardial effusion and emergency pericardiocentesis revealed blood. The patient's condition was stabilized and she underwent emergency thoracotomy with successful repair of left ventricular rupture. We discuss the literature and suggest an approach for management of patients with suspected ventricular rupture after myocardial infarction.

Successful repair of left ventricular rupture caused by blunt trauma: A case report

Successful repair of left ventricular rupture caused by blunt trauma: A case report

Successful repair of left ventricular rupture after redo mitral valve replacement

A patient with an extensive type I left ventricular rupture after a redo mitral valve replacement was successfully treated using a patch of glutaraldehyde-preserved pericardium sutured to the endocardium around the tear.

Intraventricular Patch Repair of Left Ventricular Rupture Following Mitral Valve Replacement: New Technique

Ventricular rupture after mitral valve replacement has been repaired by different techniques. Most of them have been applied from the outside of the heart. Anatomical and pathological factors mitigate the success of these techniques. Successful repair with a new technique used in 2 patients is presented. Intraventricular repair permits accurate evaluation of the lesion, eliminates tension on the tissue, and allows accurate exclusion of the tear by intraventricular insertion of a pericardial patch.

Left ventricular rupture as a complication of mitral valve replacement: Surgical experience with eight cases and a review of the literature

We are not the first to attempt repair of left ventricular rupture complicating mitral valve replacement, as 18 analogous cases have been reported earlier in the literature. Our series comprises 8 patients, 5 of who, survived. A review of these 26 cases provided several facts of interest to surgeons dealing with this complication. The rupture occurred either as a laceration in the posterior atrioventricular groove (type I, 16 of 26 patients) or as a perforation of the midportion of the left ventricle (type II, 10 of 26 patients). Intraoperative rupture (17 of 26 patients) was usually detected on termination of bypass, whereas delayed rupture (9 of 26 patients) occurred after chest closure or in the recovery room. The morality rate was about 50 per cent for the intraoperative type, and no patient survived a delayed rupture. The prognosis appeared to be most in intraoperative type II lesions. The main factors affecting the prognosis were (1) instant reinstitution of extracorporeal circulations and (2) avoidance of the circumflex coronary artery during repair of type I lesions located close to the anterolateral mitral commissure. Attempts to suture a ventricular rupture on the pressure-loaded, beating heart were always unsuccessful and frequently extended the laceration. Patients with the delayed type of rupture died of hemorrhage before they could again be placed on bypass. It may be preferable to reopen the lefr atrium in order to repair a type I laceration. In type II perforations, direct repair with buttressed sutures should be attempted from the exterior of the heart. The angulated metal cannula for drainage of the left ventricle was identified as a possible, but not previously reported, cause of myocardial perforation. It is hoped that the use of a soft cannula or a metal cannula with an angle of 60 degrees instead of 90 degrees will reduce the incidence of this complication.