Suchil Bernal L, Osornio Vargas A, Fernández Barros C
Departamento de Patología, Instituto Nacional de Cardiología, Ignacio Chávez, México.
Rev Esp Cardiol. 1992 May;45(5):333-8.
Left ventricular rupture is a serious complication of mitral valve replacement. The prevalence ranged from 0.5 to 14%, and is the principal cause of early postoperative death following mitral valve replacement. In this report we described certain morphologic observations and some clinical and epidemiological data of a series of 27 necropsy patients with midventricular rupture (type III). This complication was predominantly present in females (88.9%) with an average age of 44 +/- 11.4 years. The predominant valvular lesion was stenosis (70.4%). In all cases we found small-sized left ventricles and the ventricular wall hypertrophied. Perforation was observed in the 18.5% of the cases. In 59.2% of the patients high profile prostheses were used. Seventy-eight percent of patients died before 24 hours with refractory ventricular failure and only in the 25.9% of cases the clinical diagnoses was suspected and rupture unsuccessfully repaired. Our results suggested that age, sex, type of mitral lesion, ventricular size and type of prostheses are not risk factors for this complication. The mortality is high and the diagnosis was not suspected frequently. Midventricular rupture of the left ventricle is a lethal complication and is necessary to know all its characteristics to implement better methods of prevention and management.
左心室破裂是二尖瓣置换术的一种严重并发症。其发生率在0.5%至14%之间，是二尖瓣置换术后早期死亡的主要原因。在本报告中，我们描述了一系列27例尸检确诊为心室中部破裂（III型）患者的某些形态学观察结果以及一些临床和流行病学数据。该并发症主要见于女性（88.9%），平均年龄为44±11.4岁。主要的瓣膜病变是狭窄（70.4%）。在所有病例中，我们发现左心室较小且心室壁肥厚。18.5%的病例观察到穿孔。59.2%的患者使用了大型人工瓣膜。78%的患者在24小时内死于难治性心力衰竭，只有25.9%的病例临床诊断可疑且破裂修复失败。我们的结果表明，年龄、性别、二尖瓣病变类型、心室大小和人工瓣膜类型不是该并发症的危险因素。死亡率很高且诊断常常未被怀疑。左心室中部破裂是一种致命并发症，有必要了解其所有特征以实施更好的预防和管理方法。
