Casarotto D, Bortolotti U, Thiene G, Gallucci V, Cevese P G
Acta Chir Belg. 1977 May-Jun;76(3):297-303.
The authors report 8 cases of left heart rupture at the insertion of the posterior leaflet of the mitral valve out of 693 mitral valve replacements. Special attention is paid to the anatomy of this area and to the technique of removal of annular calcifications, when present. In reviewing the literature, the authors analyze the cases reported up to now with particular reference to the age of patients, number of valves replaced, size and amount of calcifications, volume of the left ventricular cavity, type and size of the prosthesis employed, supra- or subannular insertion, time between valve application and rupture of the heart, techniques of repair with cardiopulmonary by-pass with a beating or arrested heart. The authors maintain that this dramatic iatrogenic complication can be avoided in most instances with some modifications of the surgical technique which has been adopted in the last 200 mitral valve replacements.
作者报告在693例二尖瓣置换术中，有8例发生二尖瓣后叶附着处左心室破裂。特别关注该区域的解剖结构以及存在环形钙化时的清除技术。在回顾文献时，作者分析了迄今为止报道的病例，特别提及患者年龄、置换瓣膜数量、钙化的大小和数量、左心室腔容积、所用假体的类型和尺寸、瓣环上或瓣环下植入、瓣膜植入至心脏破裂的时间、心脏跳动或停跳时体外循环下的修复技术。作者认为，通过对过去200例二尖瓣置换术中所采用的手术技术进行一些改进，在大多数情况下可以避免这种严重的医源性并发症。
