Left ventricular rupture following mitral valve replacement due to oversize prosthesis.

Left ventricular rupture following mitral valve replacement is one of the most serious complications. We report our experience in successful treatment of type III left ventricular rupture following mitral valve replacement probably due to an oversize prosthesis. A 67-year-old woman, with the history of percutaneous transluminal mitral commissurotomy 11 years previously, underwent mitral valve replacement for mitral restenosis with a 27 mm CarboMedics mechanical bileaflet valve (Sulzer CarboMedics Inc., Austin, TX, U.S.A.). There were some difficulties in placing the entire prosthesis into the annulus at the posterior because of the oversize prosthesis. After the complete placement of the prosthesis, bulge of the left ventricular muscle was evident around the left lateral region. Following the cessation of cardiopulmonary bypass, type III left ventricular rupture, half a circular rip between the papillary muscles and posterior mitral annulus, occurred. The rip was suture-closed and a 23 mm CarboMedics valve was placed. Postoperative ultrasonic cardiography showed no prosthetic stenosis, periprosthetic leak, left ventricular pseudoaneurysm, nor left ventricular asynergy. Under cardioplegic arrest, we should not select the oversize prosthesis to prevent left ventricular rupture.