Tarkka M, Pokela R, Kärkölä P
Department of Surgery, University of Oulu, Finland.
Eur J Cardiothorac Surg. 1987;1(2):104-9. doi: 10.1016/1010-7940(87)90019-4.
Posterior left ventricular rupture (LVR) is a serious complication following mitral valve replacement (MVR), especially if occurring postoperatively with the chest already closed or the patient in the intensive care unit. Only one of the patients with this delayed type of LVR reported earlier has been treated successfully. Our experience consists of 4 such complications among 161 MVR patients, the incidence being 2.5%. Two of these patients survived. Mechanical factors seem to constitute the most important etiologic causes for this complication. Immediate reoperation must be performed, and extracorporeal circulation is generally mandatory for successful repair. The reconstruction of the ruptured posterior left ventricular wall in both surviving patients was performed from the epicardial surface of the heart using pledget sutures. The auricle of the left atrium was used to cover the site of the tear when bleeding was not stopped with pledget sutures. It usually seems possible to avoid this complication if all mechanical etiologic factors are taken into consideration. After successful correction, a pseudoaneurysm may arise and, for that reason, a cardiac echo sonography follow-up is recommended.
左心室后壁破裂（LVR）是二尖瓣置换术（MVR）后的一种严重并发症，尤其是在术后胸部已关闭或患者在重症监护病房时发生。之前报道的这种延迟型LVR患者中只有一例得到成功治疗。我们的经验是在161例MVR患者中有4例发生了这种并发症，发生率为2.5%。其中2例患者存活。机械因素似乎是该并发症最重要的病因。必须立即再次手术，体外循环通常是成功修复所必需的。两名存活患者的左心室后壁破裂重建均是从心脏的心外膜表面使用带垫片缝线进行的。当带垫片缝线无法止血时，使用左心耳覆盖撕裂部位。如果考虑到所有机械性病因，通常似乎可以避免这种并发症。成功矫正后，可能会出现假性动脉瘤，因此，建议进行心脏超声心动图随访。
