Ventricular septal defect following port-access mechanical mitral valve replacement

Interventricular septum defects are a known complication after an aortic valve replacement, but not after mitral surgery. We present a case of a 65-year-old female who underwent unsuccessful mitral valvuloplasty through port-access surgery, followed by uneventful mechanical bioprosthesis replacement. Postoperatively, the patient experienced multiple arrhythmias and recovered poorly. A systolic murmur led to echocardiography, showing an interventricular septum rupture. This was closed with 2 polypropylene pledgeted mattress sutures, via the right atrium and tricuspid valve through midsternal access. The authors believe that the most likely cause is tearing of 2 deeply placed adjacent sutures in the septum, creating localized weakening of the septum susceptible to further rupture. We therefore underline the importance of adequate exposure, especially at the notorious anterior annulus.

Automated summary

Interventricular septum defects are a known complication after aortic valve replacement, but rarely occur after mitral surgery. We report a case of a 65-year-old female who had unsuccessful mitral valvuloplasty followed by mechanical bioprosthesis replacement. Postoperatively, she developed multiple arrhythmias and poor recovery. Echocardiography revealed an interventricular septum rupture, which was repaired using polypropylene pledgeted mattress sutures via the right atrium and tricuspid valve. The tearing of deeply placed adjacent sutures is believed to be the most likely cause for localized weakening of the septum, emphasizing the importance of adequate exposure during surgery.