Rupture of left ventricle following mitral valve replacement.

A survey of the English language literature revealed 125 cases of left ventricular rupture following mitral valve replacement. In ten larger series, the incidence averaged 1.2%. Most of the ruptures were attributed either to technical maneuvers in the operation or to stretch injury produced by the untethering of the left ventricle through removal of the mural leaflet of the mitral valve. Preventive measures include modifications in operative techniques, containing pressure-volume work by the left ventricle, and probably retention of the posterior mitral leaflet. Surgical repair of the rupture with and without the aid of cardiopulmonary bypass resulted in 50% and 7% survival, respectively. With the use of cardiopulmonary bypass, external repair was followed by a 67% survival and the internal approach, by a 27% survival.