Surgical Management of Perivalvular Leakage after Mitral Valve Replacement
10.4326/jjcvs.37.13
- VernacularTitle:僧帽弁置換術後の人工弁周囲逆流に対する手術
- Author:
Yoshimasa Sakamoto
;
Kazuhiro Hashimoto
;
Hiroshi Okuyama
;
Shinichi Ishii
;
Shingo Taguchi
;
Takahiro Inoue
;
Hiroshi Kagawa
;
Kazuhiro Yamamoto
;
Kiyozo Morita
;
Ryuichi Nagahori
- Publication Type:Journal Article
- From:Japanese Journal of Cardiovascular Surgery
2008;37(1):13-16
- CountryJapan
- Language:Japanese
-
Abstract:
Perivalvular leakage (PVL) is one of the serious complications of mitral valve replacement. Between 1991 and 2006, 9 patients with mitral PVL underwent reoperation. All of them had severe hemolytic anemia before surgery. The serum lactate dehydrogenase (LDH) level decreased from 2,366±780 IU/l to 599±426 IU/l after surgery. The site of PVL was accurately defined in 7 patients by echocardiography. PVL occurred around the posterior annulus in 3 patients, anterior annulus in 2, anterolateral commissure in 1, and posteromedial commissure in 1. The most frequent cause of PVL was annular calcification in 5 patients. Infection was only noted in 1 patient. In 4 patients, the prosthesis was replaced, while the leak was repaired in 5 patients. There was one operative death, due to multiple organ failure, and 4 late deaths. The cause of late death was cerebral infarction in 1 patient, subarachnoid hemorrhage in 1, sudden death in 1, and congestive heart failure (due to persistent PVL) in 1. Reoperation for PVL due to extensive annular calcification is associated with a high mortality rate and high recurrence rate, making this procedure both challenging and frustrating for surgeons.
