Internal repair of left ventricular pseudoaneurysm late after mitral valve replacement

Abstract

Late left ventricular pseudoaneurysm is a rare complication after mitral valve replacement. Most investigators have recommended surgical repair to treat left ventricular pseudoaneurysm, since untreated left ventricular pseudoaneurysm have a high risk of rupture. Here, we report a case of a 57-year old man with left ventricular pseudoaneurysm. He had two prior mitral valve replacements 16 and 19 years ago, as well as mitral and aortic valve endocarditis causing mitral valve perivalvular leak and perforation of the aortic valve. The mitral and aortic valves were replaced with bovine pericardial valves. Left ventricular pseudoaneurysm was successfully repaired internally in our case because the internal wall at the level of the left ventricle was very fibrotic and matured.

Keywords: Complication; Mitral valve replacement; Pseudoaneurysm; Reoperation.

Figure 1:

Transoesophageal echocardiogram showing severe paravalvular mitral regurgitation originating at the lateral commissure.

Figure 2:

Cardiac CT showing a 28 mm × 28 mm pseudoaneurysm arising from the basal inferior wall of the left ventricle.

Supplementary video 1:

Intraoperative video clip showing a 5 mm circular healed old perforation of the aortic valve non-coronary cusp and the orifice of the left ventricular (LV) pseudoaneurysm that had a very fibrotic scar with scattered calcium. The LV pseudoaneurysm was closed with multiple interrupted 3–0 pledgeted polypropylene sutures, and then oversewn in two layers with a 3–0 polypropylene suture.