Van Ruyssevelt P, Massin H, Alliaume B, Damiens M
Département de chirurgie cardiaque, Hôpital de Jolimont, Haine St-Paul, Belgique.
Ann Chir. 1995;49(9):812-5.
A 70-year-old patient (NYHA IV), who required a Carpentier pericardial prosthetic valve for mitral valve replacement, developed a type 2 intraoperative left ventricular rupture (mid portion of left ventricle) with cataclysmic bleeding. A successful repair with intraventricular dacron patch was performed by suturing the patch on the prosthetic sewing ring and through the ventricular wall using pledgetted stitches. The postoperative course was satisfactory without extensive myocardial necrosis and the patient is well 7 months later without angina and with reduced dyspnoea (NYHA II). Pre and postoperative left ventricular function were similar. These ventricular injuries after mitral surgery are well known but always difficult to manage and characterized by a high mortality rate. This technique (including prosthetic valve removal and intraventricular repair) seems to provide a greater chance of success than other external repair techniques. The best treatment remains prevention and consists in preserving the posterior mitral leaflet, avoiding extensive decalcification or resection and using low profiled prosthetic mitral valves. Likewise, mitral repair must be attempted as often as possible, because, in our opinion, this complication has never been reported in conservative mitral surgery.
一名70岁患者（纽约心脏协会心功能IV级），因二尖瓣置换需要植入卡朋蒂埃心包人工瓣膜，术中发生2型左心室破裂（左心室中部）并伴有灾难性出血。通过使用带垫片缝线将涤纶补片缝在人工瓣膜缝合环上并穿过心室壁，成功地进行了心室补片修复。术后过程顺利，无广泛心肌坏死，7个月后患者情况良好，无心绞痛，呼吸困难减轻（纽约心脏协会心功能II级）。术前和术后左心室功能相似。二尖瓣手术后的这些心室损伤众所周知，但总是难以处理，且死亡率高。这种技术（包括人工瓣膜取出和心室内修复）似乎比其他外部修复技术提供了更大的成功机会。最佳治疗方法仍然是预防，包括保留二尖瓣后叶、避免广泛脱钙或切除以及使用低轮廓人工二尖瓣。同样，必须尽可能尝试二尖瓣修复，因为在我们看来，这种并发症在保守二尖瓣手术中从未有过报道。
