Ventricular septal defect following port-access mechanical mitral valve replacement

• Published in: European journal of cardio-thoracic surgery Vol. 63; no. 4
• Main Authors: Berk, Thirza A, de Kroon, Thomas L, Swaans, Martin J, van Putte, Bart P
• Format: Journal Article
• Language: English
• Published: Germany Oxford University Press 03.04.2023
• Subjects: Aged; Echocardiography; Female; Heart Septal Defects, Ventricular - diagnostic imaging; Heart Septal Defects, Ventricular - surgery; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Humans; Mitral Valve - diagnostic imaging; Mitral Valve - surgery; MVR; Port-access; Mitral valve; Ventricular septum rupture; Iatrogenic; Ventricular septum defect
• ISSN: 1873-734X; 1873-734X
• DOI: 10.1093/ejcts/ezac568

Abstract Interventricular septum defects are a known complication after an aortic valve replacement, but not after mitral surgery. We present a case of a 65-year-old female who underwent unsuccessful mitral valvuloplasty through port-access surgery, followed by uneventful mechanical bioprosthesis replacement. Postoperatively, the patient experienced multiple arrhythmias and recovered poorly. A systolic murmur led to echocardiography, showing an interventricular septum rupture. This was closed with 2 polypropylene pledgeted mattress sutures, via the right atrium and tricuspid valve through midsternal access. The authors believe that the most likely cause is tearing of 2 deeply placed adjacent sutures in the septum, creating localized weakening of the septum susceptible to further rupture. We therefore underline the importance of adequate exposure, especially at the notorious anterior annulus. Known complications after mitral valvuloplasty or valve replacement are death, resternotomy for bleeding/tamponade, myocardial infarction, stroke, infection, atrial fibrillation, prosthetic endocarditis, thromboembolism, paravalvular leak (PVL) and prosthesis failure [1].