CRP19.Successful Repair of Right Ventricular Free Wall Dissection Post Mitral Valve repair: a Complication Not Previously Reported
Presented During: AATS Cardiothoracic Resident Case Report-Poster Display
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Fadi Al-Zubaidi is a junior researcher and resident working as a research fellow at the Bristol Heart Institute, currently completing his master's degree based on investigating mitral valve surgical trends and outcomes in the United Kingdom using a large national database.
Saturday, May 6, 2023: 5:00 PM - Tuesday, May 9, 2023: 5:00 PM
Los Angeles Convention Center
Room: ePoster Area, Exhibit Hall
Description
Introduction
Mitral valve repair (MVr) in degenerative or ischaemic mitral regurgitation is a common cardiac surgical procedure. Depending on valve pathology annuloplasty ring, neochord implantation, leaflet resection and leaflet augmentation techniques are used to achieve mitral valve competence. Here we are reporting a case of "delayed right ventricular dissection" 19 days after mitral valve repair. We did not find this complication of mitral valve surgery previously reported in the literature.
Case Report
A 77-year-old gentleman with progressively worsening shortness of breath (NYHA class III) was diagnosed with severe mitral regurgitation. Transoesophageal echocardiography showed bi-leaflet mitral prolapse with impaired left ventricular function. They underwent a mitral valve repair using two Gore-Tex neo chords and a 33 mm annuloplasty ring. Post-operative echocardiogram demonstrated a competent mitral valve with trivial regurgitation. 12 days post discharge, the patient re-presented to their local hospital with presyncopal symptoms. They were found to have a retrosternal collection and a right pleural effusion. CT scan and echocardiogram were reported as suspected contained rupture of RV free wall. The patient was transferred back to our institution for further management. At re-exploration we found that the right ventricular free wall had dissected, separating the endocardium from myocardium and epicardium. The entry point was in the infundubular region and remote from any surgical sites. Successful repair was accomplished by using mechanical circulatory support in the immediate post repair period.
Conclusion
With careful planning and use of MCS a successful repair of RV free wall dissection was accomplished.
Mitral valve repair (MVr) in degenerative or ischaemic mitral regurgitation is a common cardiac surgical procedure. Depending on valve pathology annuloplasty ring, neochord implantation, leaflet resection and leaflet augmentation techniques are used to achieve mitral valve competence. Here we are reporting a case of "delayed right ventricular dissection" 19 days after mitral valve repair. We did not find this complication of mitral valve surgery previously reported in the literature.
Case Report
A 77-year-old gentleman with progressively worsening shortness of breath (NYHA class III) was diagnosed with severe mitral regurgitation. Transoesophageal echocardiography showed bi-leaflet mitral prolapse with impaired left ventricular function. They underwent a mitral valve repair using two Gore-Tex neo chords and a 33 mm annuloplasty ring. Post-operative echocardiogram demonstrated a competent mitral valve with trivial regurgitation. 12 days post discharge, the patient re-presented to their local hospital with presyncopal symptoms. They were found to have a retrosternal collection and a right pleural effusion. CT scan and echocardiogram were reported as suspected contained rupture of RV free wall. The patient was transferred back to our institution for further management. At re-exploration we found that the right ventricular free wall had dissected, separating the endocardium from myocardium and epicardium. The entry point was in the infundubular region and remote from any surgical sites. Successful repair was accomplished by using mechanical circulatory support in the immediate post repair period.
Conclusion
With careful planning and use of MCS a successful repair of RV free wall dissection was accomplished.