Left atrial thrombosis after mitral valve replacement

Thrombosis of the left atrium is a rare but troublesome complication of the mitral valve replacement (MVR). In our series of MVR, seven patients had thrombus formation of the left atrium late after MVR. These seven cases (LAT group) are compared with 53 cases (no LAT group), who are picked up randomly and have no thrombus of the left atrium after MVR, concerning to some risk factors. And the result is that the left atrial volume shows a significant difference between two groups among the risk factors. We consider that the cases with enlarged left atrium have a high risk of thrombus formation after MVR and so they also need a plication of the left atrium at the primary operation.     

Rare early prosthesis obstruction after mitral valve replacement: a case report and literature review

ABSTRACT: As a dreadful complication after the mechanical heart valve replacement, prosthetic valve obstruction caused by pannus formation occurs increasingly with time. The authors here present a case of 42-year-old woman who was urgently admitted to hospital with acute heart failure symptoms due to the mechanical mitral valve failure only 3 months after surgery. Transthoracic and transesophageal echocardiography demonstrated that the bileaflet of the mitral prosthesis were completely immobilized with only a small transvalvular jet remained. During the reoperation, the reason of the prosthetic valve obstruction was attributed to the noncircular pannus ingrowth extending from the atrioventricular side. For a better understanding of the prosthetic valve dysfunction caused by pannus formation, the authors then compile a literature review to briefly discuss the status quo of the clinical characteristics of this uncommon complication.     

Progressive mitral regurgitation which is necessitated the mitral valve replacement after partial left ventriculectomy (Batista procedure): a case report]

The patient is 61-year-old woman who underwent partial left ventriculectomy, (Batista procedure) due to dilated cardiomyopathy and multiple thromboembolism. Although postoperative course was uneventful, she has had clinical symptoms of the left heart failure due to the increased mitral valve regurgitation at the early postoperative period, gradually. Even though mitral valve regurgitation was severe, it was not apt to re-dilatate the left ventricular capacity evaluated by echocardiography. She underwent the mitral valve replacement on the 92nd postoperative day, and was once possible for weaning from cardiopulmonary bypass under the support of IABP. However, she died on the 19th postoperative day caused by sepsis. It is important to evaluate the accurate mitral valve regurgitation preoperatively for Batista procedure. Although there was the mild mitral valve regurgitation, it is essential to repair or replace the mitral valve for Batista procedure.     

Re-do mitral valve replacement using the valve-on-valve technique: a case report.

We report a repeated mitral valve replacement (re-do MVR) using the valve-on-valve technique for a degenerated bioprosthesis. A 49-year-old female, who had had a 29 mm Carpentier-Edwards mitral bioprosthesis for mitral regurgitation 20 years previously, was referred to our institution for dyspnea. She presented with pulmonary edema secondary to severe mitral bioprosthetic valve regurgitation. We replaced the degenerated mitral bioprosthesis with a 25 mm mechanical prosthesis using the valve-on-valve technique, as the struts of the bioprosthesis were embedded in the left ventricular myocardium. Removal of the bioprosthesis may be not only time-consuming but also complicated by cardiac rupture at the atrioventricular junction or the posterior left ventricular wall. The valve-on-valve technique is a simplified procedure that can avoid the potential complications of complete excision of the bioprosthesis. We believe this technique can be a useful strategy for patients with a degenerated mitral bioprosthesis.     

布鲁菌致人造瓣膜感染性心内膜炎一例

患者男,35岁.间断发热、咯血1个月.2年前因风湿性心脏病行二尖瓣置换术,3个月前到沈阳军区总医院复查经胸超声心动图等均无异常.1个月前起患者间断发热,劳动耐力进行性下降.既往有牛羊接触史.2010年4月16日来我院体检:体温38.6℃,大汗,左上肺呼吸音弱,可闻及细湿哕音,心界增大,心尖部闻及3～6级收缩期杂音,脾大,移动性浊音阴性,双下肢无水肿.ct示双肺多处斑片状、大片状毛玻璃状影,边界模糊,以左肺为重,纵隔内可见数枚直径1.0 cm左右淋巴结,双侧胸腔少量积液.腹部超声肝脏无异常,脾厚5.1 cm,长15.1 cm,经食管超声心动图见二尖瓣周五彩镶嵌返流束,宽2.5 cm,提示瓣周漏,未见赘生物.hb71 g/l,红细胞比容21.0％,红细胞沉降率62 mm/l h,血培养3次阳性,马耳他布鲁菌生长,血清布鲁菌凝集试验阳性,滴度1∶1600.患者住院l1d,给予抗感染、强心、利尿、止血等对症治疗,因不同意手术治疗转入市传染病医院,4d后因循环衰竭死亡.     

Severe tricuspid regurgitation late after aortic and mitral double valve replacement; report of a case

A 59-year-old man had undergone aortic and mitral valve replacement (DVR) for rheumatic aortic and mitral valve stenosis 15 years ago. At that time, echocardiography did not detect tricuspid regurgitation (TR), and catheterization data showed right atrial pressure v wave of 8 mmHg and pulmonary artery pressure of 27/12 (17) mmHg. One year after DVR, hepatomegaly and jugular venous dilatation appeared, and after 5 years edema of both legs became apparent. After 7 years, chest X-ray showed an increase of cardio-thoracic ratio, and for the first time, echocardiography detected mild TR. Fifteen years after DVR, severe general fatigue, shortness of breath and hepatomegaly could not be controlled with medication. Catheterization data showed right atrial pressure v wave of 23 mmHg and pulmonary artery pressure of 28/13 (17) mmHg. Right ventriculography showed progression of severe TR. Tricuspid valve replacement (TVR) was performed using a St. Jude Medical 31 M mechanical valve under natural cooling and heart beating. The tricuspid valve was only slightly thickened and no subvalvular abnormalities were seen other than a severely dilated tricuspid annulus. Postoperative course was uneventful and he was discharged 44 days after the TVR. He is currently doing well 6 years after the TVR. All terms, he did not have pulmonary hypertension or left-side heart problems. We suspect that the cause of TR was not secondary, and was included in the category of isolated TR. If the left heart is completely treated, as in this case, it is important to follow-up for signs of right heart failure, before TR is detected.     

Aortic valve replacement with the Nicks annulus enlargement procedure 12 years after mitral valve replacement.

An aortic valve replacement was successfully performed employing the Nicks annulus enlargement procedure in a case of aortic valve stenosis with small annulus 12 years after mitral valve replacement. Previous mitral valve replacement does not preclude feasibility of the Nicks procedure.     

Portal vein thrombosis after total knee replacement: a case report

We present a 74-year-old woman who developed a portal vein thrombosis following an elective total knee replacement. She had atrial fibrillation for which she was taking warfarin for anticoagulation. Seven days prior to surgery, she was instructed to discontinue warfarin and replace it with prophylactic low-molecular-weight heparin. On postoperative day 1, routine blood tests revealed deranged hepatic synthetic function, despite standard anticoagulation management. Doppler ultrasonography confirmed a portal vein thrombosis. She was treated with therapeutic doses of low-molecular-weight heparin until her international normalised ratio reached therapeutic levels. Her liver function results had normalised 2 weeks later. Portal vein thrombosis is a potentially fatal complication that is reversible if identified and treated early.     

Successful mitral valve replacement in osteogenesis imperfecta--a case report]

A 34-year-old man with osteogenesis imperfecta who underwent successful mitral valve replacement due to mitral regurgitation was reported. Cardiac disease associated with osteogenesis imperfecta is very rare and only fifteen patients were operated under the extracorporeal circulation previously. While excessive hemorrhage due to tissue fragility was observed in 7 of 15 patients, perioperative course of the case reported here was completely uneventful. The difference of hemorrhagic tendency as well as etiology of osteogenesis imperfecta will be defined according to the advance of technology in collagen genetics and biochemistry in future.     

Coronary artery spasm after aortic valve replacement: a case report

A 64-year-old man who had aortic valve regurgitation underwent aortic valve replacement. There had been no history of angina pectoris or taking of calcium channel blockers. When the operation was nearly completed, unexpected hemodynamic collapse happened without ST-segment changes on the ECG monitoring. Resuscitation was successful by cardiac massage, pacing and administration of catecholamine. Thereafter the same episodes occurred several times. At the 6th attack on postoperative day 7, we confirmed the ST-segment elevation using 12-lead-ECG, thus coronary artery spasm was diagnosed. Thereafter calcium channel blocker and coronary vasodilator were administered continuously. There has been no attack since postoperative day 13. Though postoperative coronary arteriography showed no anatomical changes compared with preoperative study, direct injection of ergonovine made the right coronary artery spastic, but not the left. We emphasized that perioperative coronary artery spasm may happen not only in the coronary artery surgery but in any other cardiac operations.     

Successful repair of the left ventricular wall rupture after mitral valve replacement of an octogenarian; report of a case

The left ventricular wall rupture is not only a rare complication after mitral valve replacement, but also a high mortality disease. We have encountered a case of this complication after removal of the extracorporeal circulation in an octogenarian female after mitral valve replacement with Carpentier-Edwards (25 mm). It could be successfully repaired from outside the heart on the cardiopulmonary bypass without second cardiac arrest. Repair from inside the heart using extracorporeal circulation and cardioplesia is generally recommended because of the accuracy. However, second cardiac arrest might be a risk of postoperative complications in octogenarians. Hence, prevention is the most important. And operative strategy for the repair is also important in these patients.     

Repair of atrioventricular disruption after mitral valve replacement utilizing commando procedure principles

Atrioventricular rupture is a life-threatening complication of mitral valve replacement. We present how incising the intervalvular fibrosa critically improves exposure. The aortic valve sacrifice allows access to a large atrioventricular dissociation defect and reliable repair of the anterolateral aspect of mitral valve annulus.     

Supravalvular aortic stenosis syndrome with advanced mitral regurgitation requiring extended aortoplasty and mitral valve replacement: a case report

This is a case report of a 28-year-old male, suffering from supravalvular aortic stenosis (systolic pressure gradient 60 mmHg) and severe mitral regurgitation associated with elfin face and mental retardation. Severely prolapsed mitral valve with elongated chordae tendineae was replaced with Bj?rk-Shiley mitral valve prosthesis. Simultaneously, extended aortoplasty was carried out using Doty's method. His postoperative course was uneventful. Catheterization study, carried on one month after surgery, revealed complete disappearance of supravalvular aortic stenosis and mitral regurgitation. In review of the literature, as far as we know, report of successful combined correction for supravalvular aortic stenosis and mitral regurgitation is extremely rare.     

A case of pyoderma gangrenosum after mitral valve replacement]

A 48-year-old male with treated hypothyroidism underwent mechanical valve replacement for mitral valve regurgitation. After the operation, the patient developed progressive median chest wound ulceration. The wound did not heal with conventional therapies for mediastinitis such as administration of antibiotics, debridement of necrotic tissue or continuous irrigation. The entire surgical wound opened spontaneously. Bacterial cultures yielded negative and the wound biopsy specimen revealed non-specific inflammatory change. The anti-TSH receptor antigen level was high. Pyoderma gangrenosum based on auto-immune deficiency was diagnosed and high dose corticosteroid therapy was started. The wound healed completely in 5 months.