The Annals of Thoracic Surgery, Vol 31, 105-110, Copyright © 1981 by The Society of Thoracic Surgeons
Isolated mitral valve replacement and ventricular rupture: presentation of 6 patients
F Gosalbez, FA de Linera, JL Cofino, JL Naya, J Rodriguez and A Ortuna
The cases of 6 patients who had ventricular wall rupture after isolated
mitral valve replacement and were seen in our service are reviewed. In the
first 2, the main lesion was mitral stenosis and calcification was severe.
Injury to the ventricular myocardium during removal of the valve was the
causative factor in 1 and the most likely explanation in the other. In the
other 4 patients, the dominant lesion was insufficiency. Calcium was
absent, and fibrosis of the valves was minimal. Defects of technique were
not obvious. All perforations were beneath the annulus. The first of these
4 latter patients underwent operation just after cardioplegic solutions
were introduced for myocardial protection in our service. During that
period, the incidence of ventricular wall rupture was 7.3% for mitral valve
replacement (55 patients). Causing 3 deaths, it became the most important
mortality factor. After reviewing the problem, we decided to change our
technique by leaving practically all the posterior leaflet and most of the
chords intact and placing sutures through fibrous tissue only, never into
muscle, as had already been suggested. Since then, we have not seen another
rupture in 23 valve replacements.
