ABSTRACT
Prosthetic mitral valve reoperation complicated by atrioventricular groove pseudoaneurysm and circumflex ventricular fistula is presented. Ligation of the circumflex artery during mitral valve replacement is implicated after review of a previous cardiac angiogram.
Subject(s)
Fistula/etiology , Heart Aneurysm/etiology , Heart Diseases/etiology , Heart Valve Prosthesis/adverse effects , Female , Humans , Middle Aged , Mitral Valve/surgery , ReoperationABSTRACT
Delayed posterior wall (PW) peak in the detection of PW asynergy was studied by M-mode echocardiography in 53 patients with angiographically proven PW aneurysm, hypokinesis and normal PW. The timing of the PW peak was evaluated by the intervals between (1) the aortic valve closure (Ac) and the PW peak, and (2) the R wave of the electrocardiogram and the PW peak (R-peak). The PW excursion predicted only 39 percent with aneurysm and none with hypokinesis. In contrast, 13 of 18 patients with aneurysm and 4 of 13 patients with hypokinesis demonstrated significantly delayed PW peaks occurring between 0.05 and 0.1 sec following Ac (normal 0 to 0.05 sec). A new index, a ratio of R-peak to ejection time (R-peak/ET) of 1.35 or greater was found to be highly indicative of PW aneurysm in 16 of 18 patients.
