Subject(s)
Coronary Angiography , End Stage Liver Disease , Heart Rate , Ivabradine , Ivabradine/therapeutic use , Ivabradine/pharmacology , Humans , Heart Rate/drug effects , End Stage Liver Disease/drug therapy , Male , Middle Aged , Computed Tomography Angiography , Female , Coronary Artery Disease/drug therapy , Coronary Artery Disease/diagnostic imaging , Cardiovascular Agents/therapeutic use , Cardiovascular Agents/pharmacology , Benzazepines/therapeutic use , Benzazepines/pharmacology , AgedABSTRACT
Mitral valve surgery (MVS), with repair preferred to replacement, is a common procedure for the treatment of severe primary mitral regurgitation related to leaflet prolapse. Structural complications after MVS include left ventricular outflow obstruction, paravalvular leak and atrial septal defect. Intraoperative transoesophageal echocardiography and predischarge transthoracic echocardiography (TTE) specifically screen for these complications. Ventricular septal defect (VSD), a known complication after aortic valve surgery, is rarely reported after MVS. Recently, unsuccessful valvuloplasty prior to replacement was suggested as a risk factor. We present such a case and explore mechanisms with advanced cardiac imaging. In this case, the patient was found to have an elongated membranous septum that likely predisposed her to septal injury. Finally, we provide guidance on specific transoesophageal/transthoracic echocardiography views to avoid a missed diagnosis.