One of the dreaded complications of mitral valve replacement is ventricular rupture. It is difficult to manage and so it is better avoided. There are thee sites of LV ruphlre:
1) At the insertion of papillary muscle due to over enthusiastic resectioil of after traction.
2) At the annular level when there is excessive calcification and fusion of posterior leaflet.
3) Midway between papillary muscle insertion and annulus.
The last one is thought to be of haemodynamic origin and occurs when the whole mitral apparatus has been removed. The problem starts as a haematoma and over a period of time it extends leading to complete rupture. This is managed by going on bypass and by suturing a large pericardial patch covering the whole epicardium covering the area of rupture. Mortality is high - more lhan 75 per cent.
Valve Thrombosis
Valve thrombosis causes sudden deterioration of the patient's haemodyarnics. A stuck valve may produce both stenosis and incompetence. If diagnosed early some of them could be managed by thrombolysis. Clinically it's diagnosed by the muffling of the prosthetic sounds and occurrence of new murmur. Diagnosis is confiied by echocardiography. Urgent surgery is required in these cases.Under cardio pulmonary bypass thrombectomy and clearing of the whole valve has to be done.. If it is not possible to clear the inaccessible parts of the valve, it will have to be replaced. One of the advantages of bileaflet valve is that even when one leaflet is stuck the other one will be able to maintain reasonably good haemodynarnics. This helps the surgeon to perform a semi-elective operation.
Haemolysis
Mechanical valves, bioprosthetic valves as well as valves repaired with annuloplasty rings may cause haemolysis and related anaemia. This is more common when there is para valvar leak, which often results in a turbulent jet,Laboratory investigations reveal anaemia, elevated serum LDH and high reticulocyte aunt. The definitive treatment is by reoperation, fixing the para valvar leak or by replacement with another valve.
Other Complications
Bioprosthetic valves have a tendency for degeneration, calcification or cusp perforation. Current models have overcome many of these problems.Calcification and degeneration of a valve occur faster in children. So it is not advisable to insert these valves in children. In adults also they may have to be to be replaced after ten years.
1) At the insertion of papillary muscle due to over enthusiastic resectioil of after traction.
2) At the annular level when there is excessive calcification and fusion of posterior leaflet.
3) Midway between papillary muscle insertion and annulus.
The last one is thought to be of haemodynamic origin and occurs when the whole mitral apparatus has been removed. The problem starts as a haematoma and over a period of time it extends leading to complete rupture. This is managed by going on bypass and by suturing a large pericardial patch covering the whole epicardium covering the area of rupture. Mortality is high - more lhan 75 per cent.
Valve Thrombosis
Valve thrombosis causes sudden deterioration of the patient's haemodyarnics. A stuck valve may produce both stenosis and incompetence. If diagnosed early some of them could be managed by thrombolysis. Clinically it's diagnosed by the muffling of the prosthetic sounds and occurrence of new murmur. Diagnosis is confiied by echocardiography. Urgent surgery is required in these cases.Under cardio pulmonary bypass thrombectomy and clearing of the whole valve has to be done.. If it is not possible to clear the inaccessible parts of the valve, it will have to be replaced. One of the advantages of bileaflet valve is that even when one leaflet is stuck the other one will be able to maintain reasonably good haemodynarnics. This helps the surgeon to perform a semi-elective operation.
Haemolysis
Mechanical valves, bioprosthetic valves as well as valves repaired with annuloplasty rings may cause haemolysis and related anaemia. This is more common when there is para valvar leak, which often results in a turbulent jet,Laboratory investigations reveal anaemia, elevated serum LDH and high reticulocyte aunt. The definitive treatment is by reoperation, fixing the para valvar leak or by replacement with another valve.
Other Complications
Bioprosthetic valves have a tendency for degeneration, calcification or cusp perforation. Current models have overcome many of these problems.Calcification and degeneration of a valve occur faster in children. So it is not advisable to insert these valves in children. In adults also they may have to be to be replaced after ten years.
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