Surgical Management of Perivalvular Leakage after Mitral Valve Replacement

(Department of Cardiac Surgery, Jikei University School of Medicine, Tokyo, Japan)

Yoshimasa Sakamoto Kazuhiro Hashimoto Hiroshi Okuyama
Shinichi Ishii Shingo Taguchi Takahiro Inoue
Hiroshi Kagawa Kazuhiro Yamamoto Kiyozo Morita
Ryuichi Nagahori
Perivalvular leakage (PVL) is one of the serious complications of mitral valve replacement. Between 1991 and 2006, 9 patients with mitral PVL underwent reoperation. All of them had severe hemolytic anemia before surgery. The serum lactate dehydrogenase (LDH) level decreased from 2,366}780 IU/l to 599}426 IU/l after surgery. The site of PVL was accurately defined in 7 patients by echocardiography. PVL occurred around the posterior annulus in 3 patients, anterior annulus in 2, anterolateral commissure in 1, and posteromedial commissure in 1. The most frequent cause of PVL was annular calcification in 5 patients. Infection was only noted in 1 patient. In 4 patients, the prosthesis was replaced, while the leak was repaired in 5 patients. There was one operative death, due to multiple organ failure, and 4 late deaths. The cause of late death was cerebral infarction in 1 patient, subarachnoid hemorrhage in 1, sudden death in 1, and congestive heart failure (due to persistent PVL) in 1. Reoperation for PVL due to extensive annular calcification is associated with a high mortality rate and high recurrence rate, making this procedure both challenging and frustrating for surgeons.
@Jpn. J. Cardiovasc. Surg. 37: 13-16 (2008)