Patch Dehiscence After Mitral Valve Repair by Posterior Mitral Leaflet Augmentation at Weaning From Cardiopulmonary Bypass

TL;DR

A rare complication of mitral valve repair surgery was identified using advanced imaging techniques, allowing for immediate detection and management.

Contribution

This case highlights the use of intraoperative TEE with 3D imaging to detect a rare post-surgical complication during mitral valve repair.

Findings

A 76-year-old patient underwent mitral valve repair for ischemic MR.

Intraoperative TEE revealed a prolapsed posterior mitral leaflet and a flipped patch after surgery.

Three-dimensional TEE imaging enabled prompt detection of the complication.

Abstract

The treatment for ischemic mitral regurgitation (MR) involves a combination of medical management and, in certain cases, surgical intervention. The approach depends on the severity of the condition, underlying causes, and the patient's overall health. A 76-year-old male with heart failure refractory to medical management because of ischemic MR was considered for a mitral valve repair surgery with a posterior mitral leaflet augmentation technique. Following the repair of the mitral valve and the cessation of the initial cardiopulmonary bypass (CPB), a prolapse of the posterior mitral leaflet, which had not been detected before the surgery, was revealed by intraoperative transesophageal echocardiography (TEE). A thorough inspection of the repaired mitral valve after cardiac arrest during the second CPB unveiled a loose suture at the edge of the valve and an inverted pericardium, indicating that the patch had flipped upward. Although complications of this type following the augmentation of the mitral posterior leaflet are rare, we promptly detected it using TEE, which incorporates three-dimensional imaging.

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