ABSTRACT
A 71-year-old woman with a history of closed commissurotomy for mitral valve stenosis 44 year ago, was diagnosed with left ventricular aneurysm by transthoracic echocardiography. She had no symptom of left ventricular aneurysm. Since there was a high risk of left ventricular rupture, we decided to undertake surgical treatment. During the surgery, we found artificial material near the left ventricular aneurysm. We resected the aneurysm wall and closed the ventricular wall using felt strip reinforcement. The wall of the aneurysm had no myocardium upon pathological examination. We diagnosed that it was a left ventricular pseudoaneurysm, and it seemed to be formed by blood oozing from the apical repair point of the hole for the dilator to perform mitral valvulotomy. The postoperative course was uneventful and she was discharged on postoperative day 20. Left ventricular pseudoaneurysm often results after myocardial infarction, and reports after cardiac surgery are rare, except in cases after mitral valve replacement. We hereby report our experience with this rare case
ABSTRACT
A 69-year-old woman with a medical history of mitral valve replacement for infective endocarditis 14 years previously was recently admitted after being given a diagnosis with multiple cerebral infarction along with headache and speech disturbance. After emergency admission, both transthoracic and transesophageal echocardiographies revealed multiple, extensive vegetation on the mitral prosthetic valve. Based on these findings, we diagnosed prosthetic valve endocarditis with cerebral septic embolization ; and immediate mitral valve re-replacement surgery was performed. During the operation, a complication occurred when the left ventricular posterior wall ruptured during withdrawal from the cardiopulmonary bypass after mitral valve re-replacement. After a second cross-clamp and resection of the mitral prosthetic valve, we repaired the myocardial laceration and repeated the mitral valve re-replacement. We selected the following two methods from different approaches to repair the left ventricular rupture : (a) exclusion of the myocardial laceration using a bovine pericardial patch (intracardiac approach) ; and (b) direct suturing of the bleeding epicardium (extracardiac approach).Seven days after the surgery, computed tomography (CT) revealed a pseudoaneurysm in the left ventricular posterior wall. Several follow-up examinations using CT and echocardiography revealed gradual enlargement of the pseudoaneurysm. At 112 days after previous surgery, we successfully repaired the pseudoaneurysm through left lateral thoracotomy using the femorofemoral bypass with hypothermia. In the final surgery, we closed the orifice of the pseudoaneurysm using bovine pericardium. This case highlighted that left thoracotomy using a femorofemoral bypass with hypothermia could be a useful approach to address a left ventricular posterior wall pseudoaneurysm.
ABSTRACT
<p>A 66-year-old man experiencing fever and dyspnea was transferred to our hospital 2 years ago. He had been on hemodialysis for 30 years due to chronic renal failure and was observed as having aortic stenosis for 5 years. Severe mitral regurgitation and complete atrioventricular block caused by infective endocarditis (IE) were noted. Thus, he emergently underwent double-valve replacement (DVR) and pacemaker implantation. The range of infection extended widely to the right atrium and atrioventricular septum beyond the mitral annulus. The infection was suppressed by perioperative antibiotic therapy. Transthoracic echocardiography (TTE) revealed a cavity approximately 30 mm in diameter in the left ventricle, which was located under the mitral annulus, and it extended to the right atrium 3 months after the operation. A diagnosis of left ventricular pseudoaneurysm associated with IE was then made. Because of progressive expansion of the aneurysm, we performed another operation 2 years after the previous one. The pseudoaneurysm was located in the region of the Koch's triangle, which indicated that it was caused by mitral annular abscess. We closed the orifice of the aneurysm approximately 20 mm in diameter with a polyester patch with a diameter of 35 mm. Postoperative TTE showed that the pseudoaneurysm was thrombosed and had no blood flow. Pathological examination of the wall of the pseudoaneurysm revealed that it consisted of fibrous tissues without myocardium. We encountered a rare case treated by patch closure for the left ventricular pseudoaneurysm after DVR associated with IE.</p>
ABSTRACT
We present a case of left ventricular pseudoaneurysm, which is a very rare and fatal complication of cardiac procedures such as mitral valve replacement. A 55-year-old woman presented to the Department of Thoracic and Cardiovascular Surgery at Hanyang University Seoul Hospital with chest pain. Ten years prior, the patient had undergone double valve replacement due to aortic regurgitation and mitral steno-insufficiency. Surgical repair was successfully performed using a prosthetic pericardial patch via a left lateral thoracotomy.
Subject(s)
Female , Humans , Middle Aged , Aneurysm, False , Aortic Valve Insufficiency , Chest Pain , Mitral Valve , Seoul , ThoracotomyABSTRACT
A 70-year-old man who had undergone felt repair for a left ventricular free wall rupture associated with acute myocardial infarction at age 66. A computed tomography at 4 years postoperatively showed left ventricular pseudoaneurysm and a 1-cm perforating hole. A patch closure with a Dacron patch was performed using cardiopulmonary bypass under ventricular fibrillation through a left thoracotomy. The postoperative course was uneventful and he was discharged on the 18th postoperative day.