Successful Repair of Postoperative Left Ventricular Rupture following Mitral Valve and Aortic Valve Replacement with Tricuspid Valve Annuloplasty in Chronic Renal Failure / 日本心臓血管外科学会雑誌

ABSTRACT

Left ventricular rupture is one of the major lethal complications of mitral valve replacement. A case of successful repair of postoperative left ventricular rupture following mitral valve and aortic valve replacements, tricuspid valve annuloplasty in chronic renal failure is described. The patient was a 58-year-old male and suffered from mitral stenosis and regurgitation with left atrial thrombi, aortic stenosis and regurgitation, and tricuspid regurgitation. It has been 13 years since the patient was operated on for mitral stenosis with open mitral commissurotomy. Mitral valve and aortic valve replacements, tricuspid valve annuloplasty was performed under cardiopulmonary bypass and cardioplegic arrest using the extracorporeal ultrafiltration method (ECUM) and continuous venovenous hemodialysis (CVVH). The patient has been in good condition during weaning from cardiopulmonary bypass. After the operation, left ventricular rupture occurred due to transient high blood pressure in the operating room. The patient was quickly put back on cardiopulmonary bypass. In this case, the rupture occurred although no technical errors were thought to be made. The site of the rupture was type II in the Treasure classification. The left ventricular rupture was repaired with the patch closure method under cardiopulmonary bypass and cardioplegic arrest. The postoperative cardiac function was relatively well preserved. More attention should be paid to cases in this type of condition; mitral stenosis, long history, multiple valve replacements, and chronic renal failure. This patient died from sepsis caused by the infectious route of continuous ambulatory peritoneal dialysis (CAPD) on the 61st postoperative day.