C. Kuhnen et al., RUPTURE OF THE LEFT-VENTRICLE AFTER MITRA L-VALVE REPLACEMENT - PATHOLOGICAL-ANATOMICAL FINDINGS, Der Pathologe, 18(3), 1997, pp. 238-242
The rupture of the free left ventricular wall is considered a serious
complication following mitral valve replacement. We report about 3 cas
es characterized by similar pathologic-anatomical findings within the
region of the left ventricle after mitral valve replacement. Following
resection of the original and pathologically altered mitral valve and
implantation of a prothesis, rupture of the left ventricular wall occ
urred in short time intervalls ranging from 1 to 12 h postoperatively.
All cases represented a transverse midventricular disruption located
between the mitral valve anulus and the resected papillary muscles. Th
e histologic findings included necrotic, damaged myocardial structures
with considerable bleeding to the interstitium. Inflammatory infiltra
tion could be detected within the myocardial defects. Abnormal patholo
gic findings of the coronary arteries or intraoperative lesions could
be excluded by thorough autoptic studies. Because of central localizat
ion of the ventricular disruption between the mitral valve anulus and
the papillary muscles a direct traumatic myocardial injury caused by m
itral valve protheses is to be excluded. When taking into account seve
ral reports from literature in combination with our described findings
in autopsy, a loss of contractile integrity of the left ventricle fol
lowing resection of mitral valve apparatus, especially the chordae ten
dinaea, should be considered as primary cause for this type of ventric
ular rupture. This destabilization will lead to a regionally stressed
myocardial ''stretching'' which finally results in rupture of the left
ventricular free wall. The described pathogenetic concept seemingly r
epresents the decisive mechanism of this transverse midventricular dis
ruption in all 3 cases. To prevent such post-operative complications,
only very limited resection of the mitral valve apparatus should be pe
rformed to maintain parts of the chordae tendineae.