Author + information
- Received May 31, 2016
- Revision received July 19, 2016
- Accepted July 28, 2016
- Published online October 24, 2016.
- Ana R. Godinho, MDa,∗ (, )
- João C. Silva, MDa,
- Pedro B. Almeida, MDa,
- Jorge Almeida, MDb and
- Maria J. Maciel, PhDa
- aDepartment of Cardiology, Hospital São João, Porto, Portugal
- bDepartment of Cardiothoracic Surgery, Hospital São João, Porto, Portugal
- ↵∗Reprint requests and correspondence:
Dr. Ana Rita Pinto Biscaia Godinho, Centro Hospitalar de São João, Serviço de Cardiologia, Alameda Professor Hernâni Monteiro 4200-319 Porto, Portugal.
A 75-year-old woman with severe mitral regurgitation due to chordal rupture underwent mitral valve replacement with a 27-mm St. Jude Medical bioprosthesis. Intraoperative transesophageal echocardiography (TEE) showed a normal functioning prosthesis. Postoperative period was uneventful and the patient was discharged on postoperative day 11. Three months later heart failure ensued. TEE disclosed dissection of the left atrium (LA) wall complicated by rupture of the anterior aspect of the mitral annulus (Figures 1A to 1C, Online Videos 1 and 2).
Considering the patient’s poor clinical condition, percutaneous intervention guided by TEE was undertaken. Atrial dissection was crossed retrograde and an arterial-venous loop was performed by transeptal puncture. Low pressure inflation of a balloon until complete flow stop was used to assess the dimension of the defect and to choose the appropriate device (Figures 1D and 1E). A 6-mm Amplatzer ventricular septal device occluder (St. Jude Medical, Minneapolis, Minnesota) was implanted anterograde. The device pulled the endocardium and the epicardial layer close together occluding the false lumen. Effective occlusion of the rupture with almost complete disappearance of the atrial dissection was confirmed by TEE. A small posteromedial leak was left untouched.
Beforehand, this rare and dreadful complication of mitral valve surgery could only be treated by open approach (1). Here we describe an alternative treatment for patients in whom the surgical risk is considered prohibitive.
For supplemental videos and their legends, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 31, 2016.
- Revision received July 19, 2016.
- Accepted July 28, 2016.
- 2016 American College of Cardiology Foundation