All Title Author
Keywords Abstract

Publish in OALib Journal
ISSN: 2333-9721
APC: Only $99


Relative Articles


Cardiac Gated Computed Tomography Used to Confirm Iatrogenic Aortic Valve Leaflet Perforation after Mitral Valve Replacement

DOI: 10.1155/2013/528439

Full-Text   Cite this paper   Add to My Lib


Aortic insufficiency from iatrogenic valve perforation from nonaortic valve operations is rarely reported despite the prevalence of these procedures. Rapid diagnosis of these defects is essential to prevent deterioration of cardiac function. In this paper, we describe a young man who reported to our institution after two open cardiac surgeries with new aortic regurgitation found to be due to an iatrogenic perforation of his noncoronary aortic valve cusp. This defect was not appreciated by previous intraoperative transesophageal echocardiography and was inadequately visualized on follow-up transthoracic and transesophageal echocardiograms. In contrast, cardiac gated computed tomography clearly visualized the defect and its surrounding structures. This case highlights the utility of cardiac gated computed tomography for cases of suspected valvular perforation when echocardiography is not readily available or inadequate imaging is obtained. 1. Introduction Aortic insufficiency resulting from iatrogenic aortic valve perforation during nonaortic valve cardiac operations is a rarely reported complication despite the prevalence of these procedures. Rapid diagnosis and treatment of these defects are essential in preventing deterioration of cardiac function. This case report describes a young man with a history of mechanical mitral valve placement in 2004 and reoperation at an outside facility in 2009 secondary to prosthetic valve endocarditis who presented to our institution two months after the second procedure with progressive dyspnea and decompensated heart failure. He was found to have new severe aortic regurgitation from an iatrogenic perforation of his noncoronary aortic valve cusp. Intraoperative transesophageal echocardiography (TEE) is established as an effective modality to detect these injuries during valvular replacement surgeries but in this case failed to detect a defect. Making the diagnosis involved use of transthoracic echocardiography (TTE), repeat TEE, and cardiac gated computed tomography (CT) to fully characterize the defect. This case highlights the diagnostic utility of cardiac CT in cases of new valvular insufficiency when iatrogenic injury is suspected. 2. Case Presentation In September 2004, a 24-year-old male presented with progressive dyspnea on exertion, paroxysmal atrial fibrillation, malaise, and peripheral eosinophilia. Initial evaluation showed a left atrial mass and a separate mass adherent to the mitral valve for which the patient underwent surgical resection and mechanical mitral valve replacement. The diagnosis of


[1]  R. S. Ballal, E. F. Mahan III, N. C. Nanda, and R. Sanyal, “Aortic and mitral valve perforation: diagnosis by transesophageal echocardiography and Doppler color flow imaging,” The American Heart Journal, vol. 121, no. 1, part 1, pp. 214–217, 1991.
[2]  A. C. Hill, R. C. Bansal, A. J. Razzouk, M. Liu, L. L. Bailey, and S. R. Gundry, “Echocardiographic recognition of iatrogenic aortic valve leaflet perforation,” Annals of Thoracic Surgery, vol. 64, no. 3, pp. 684–689, 1997.
[3]  A. R. Mehta and R. Hunsaker, “Iatrogenic aortic incompetence after mitral valve replacement,” Journal of Cardiothoracic and Vascular Anesthesia, vol. 21, no. 2, pp. 276–278, 2007.
[4]  M. Santiago, M. A. El-Dayem, G. Dimitrova, and H. Awad, “Missed diagnosis of iatrogenic acute aortic insufficiency after mitral valve surgery,” International Anesthesiology Clinics, vol. 49, no. 2, pp. 26–31, 2011.
[5]  T. V. Bilfinger, F. C. Seifert, A. M. Vallone, and T. M. Biancaniello, “Aortic valve injury 10 years after tetralogy of fallot repair,” Pediatric Cardiology, vol. 15, no. 2, pp. 100–102, 1994.
[6]  F. Sabzi, H. Teimouri, and A. Moloodi, “Subacute aortic regurgitation as a rare presentation of iatrogenic aortic valve leaflet perforation,” Acta Medica Iranica, vol. 47, no. 6, pp. 499–501, 2009.
[7]  J. J. Woo, Y. Y. Koh, K. S. Chang, and S. P. Hong, “A case of iatrogenic aortic valve leaflet perforation after closure of a ventricular septal defect,” International Journal of Cardiovascular Imaging, vol. 26, no. 1, pp. 169–172, 2010.
[8]  K. A. Thompson, T. Shiota, K. Tolstrup, S. V. Gurudevan, and R. J. Siegel, “Utility of three-dimensional transesophageal echocardiography in the diagnosis of valvular perforations,” The American Journal of Cardiology, vol. 107, no. 1, pp. 100–102, 2011.
[9]  A. Rother, B. Smith, D. H. Adams, and C. D. Collard, “Transesophageal echocardiographic diagnosis of acute aortic valve insufficiency after mitral valve repair,” Anesthesia and Analgesia, vol. 91, no. 2, pp. 499–500, 2000.
[10]  A. J. Taylor, M. Cerqueira, J. M. Hodgson et al., “ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography: a report of the American college of cardiology foundation appropriate use criteria task force, the society of cardiovascular computed tomography, the American college of radiology, the American heart association, the American society of echocardiography, the American society of nuclear cardiology, the north American society for cardiovascular imaging, the society for cardiovascular angiography and interventions, and the society for cardiovascular magnetic resonance,” Journal of the American College of Cardiology, vol. 56, no. 22, pp. 1864–1894, 2010.


comments powered by Disqus

Contact Us


WhatsApp +8615387084133

WeChat 1538708413