During a 10-year period.

During a 10-year period, we have collisioned 6 patients (mean age, 612 years) with left ventricular break following mitral valve replacement, with an overall incidence of 18 percent Four patients had early dissolution one had delayed rupture, and common had late rupture with a false aneurysm formation. Among four patients with early break there were two patients with external repair by way of using a large ventricular patch and sum of two units patients with internal and the external repair through removing the prosthetic valve and patching the pair the inside and outside of the ventricle. In a patient with delayed hostility bleeding from an epicardial hematoma was recognized along the atrioventricular furrow in the intensive care unit. It was possible to rule bleeding by packing the gauze, hemostatic cellulose [Surgicel], and fibrin gelatine Late rupture was recognized as a false aneurysm; however, there were no clinical symptoms. All patients survived the surgery on the other hand two patients with early feud subsequently died. One of these died of renal failure and the other died of multiple organ failure. The sites of dissolution in all patients were in accordance with impressed sign 1 rupture (Treasure's classification); however, an autopsy review demonstrated the initial laceration in single case was recognized in the membranous septum 5 mm below the mitral ring and expanded to the posterior atrioventricular grouve These findings remind of that the injury in the anterior mitral annulus could lead to representation 1 rupture, although in the posterior mitral annulus more commonly Since 1987 we have preserv the posterior leaflet with attached chordae when the mitral valve was fragile add myxomatous. As a ensue no instances of left ventricular feud were encountered.

breach of the left ventricle has been single in kind of the major complications of mitral valve replacement. It is an infrequent still potentially lethal complication. In the review of Karlson et al,[1] the incidence averaged 12 percent and approximately 75 percent of the patients died of this complication. equal though many predisposing risk factors have been reported for the etiology of this complication,[1,2] it is difficult to define the etiology of contention and note the precise localization of disruption of the myocardium in greatest in number cases.[3,4]

We report our experience of six patients with feud of left ventricle, with an emphasis forward the surgical repair and deductions of this complication.

Methods

subject of attention Population

Between January 1980 and December 1990 328 patients underwent mitral valve replacement at Osaka National Hospital. Among these patients, six patients (18 percent) had left ventricular disruption following mitral valve replacement. There were three male and three female patients with a mean age of 612 years (range, 48 to 73 years). Of these six patients, united had rheumatic mitral stenosis, three had myxomatous mitral regurgitation, and pair had reoperation associated with the dysfunction of a prosthetic heart valve.

Operative conducts of Mitral Valve Replacement

Operative techniques were standardized and performed with cardiopulmonary bypass in subordination to moderate hypothermia. In all manner of proceedings potassium crystalloid cardioplegia was used for intraoperative myocardial protection. Interrupted mattress line of junctions were used to anchor the valve to the mitral annulus. the couple anterior and posterior leaflets were excised with the attached chordae in the four patients who underwent the first replacement of the mitral valve for the first time. grave profile tilting disk valves were implanted in five patients, and a bioprosthetic valve in one

attack Sign, and Repair of Rupture

The storm of rupture can be divided into three distinct time patterns as reported by the agency of Karlson et al.[1] Early feud is defined as an termination occurring in the operating compass anytime after discontinuation of cardiopulmonary bypass; delayed contention is defined as an marked occurrence in the recovery room; and late breach occurs days to years after valve replacement and not aways as false aneurysm of the left ventricle. In this regard, four patients had early breach one had delayed rupture, and united had late rupture with a false aneurysm formation.

In all four patients with early break the predominant sign of quarrel was an epicardial hematoma along the atrioventricular furrow after resumption of cardiac ejection prior to discontinuation of cardiopulmonary bypass. It was difficult to make precise localization of a myocardial tear in the spreading hematoma beneath the fatty tissue in this area. sum of two units patients had successful treatment by dint of external repair and the other pair patients had internal repair with the additional external repair. External repair was performed subordinate to cardiopulmonary bypass, and we sutur a Dacron patch above the area of hematoma forward the external ventricular surface, using hard mattress sutures passed beneath the coronary sailing crafts in the atrioventricular groove.

We combined the internal and external repairs in couple patients under cardiopulmonary bypass from patching the mitral annulus and the outside of the ventricle. This operation involved the reopening of the left atrium and correction from within the cardiac chamber with the removal of the prosthesis. Because the mitral ring was involved in the extensive hematoma, we reinforced the mitral annulus with circumferential Dacron felt The intra-aortic balloon interrogate was used in all patients to unload the left ventricle and mould tension on the repair.

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