Atrioventricular Groove Rupture After Mitral Valve Replacement in A Patient With Atrial Fibrillation Secondary to Rheumatic Cardiopatia: Case Report
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Abstract
Introduction: Atrioventricular sulcus lesion (AVGD) is a catastrophic complication of mitral valve surgeries that occurs in less than 2% of the population, with a mortality of 90%. Left ventricular rupture after mitral valve (MVR) replacement should be diagnosed immediately and repaired without hesitation. There are numerous complications described and known after MVR, such as thromboembolism, structural valve degeneration and endocarditis, paravalvular leakage, conduction irregularities in the pathway and bleeding.
Case presentation: We present the case of a female patient with a history of rheumatic heart disease with double mitral injury and atrial fibrillation, in which severe mitral stenosis was documented with ECOTT reflecting thrombi of heterogeneous appearance occupying almost entirely left atrium. Programmed for left auriculotomy, valve replacement and thrombus exceresis, resulting in the procedure lesion of the atrioventricular groove meriting packing of the same and placement of mediastinal probes, with subsequent admission to post-surgical coronary care unit.
Conclusions: At present, atrioventricular groove rupture is a rare event with increased mortality, the incidence depends on age and associated risk factors in the patient, In our case, rheumatic heart disease generates arrhythmias as a procoagulant state. Although the rupture can be repaired in a second surgical time, follow-up and post-operative care require comprehensive medical equipment and continuous hemodynamic surveillance.
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References
I. Dobrilovic, N., Raman, J., Fingleton, J. G., Maslow, A., & Singh, A. K. (2017). Long-term outcomes of external repair as a rescue operation for atrioventricular groove disruption. The Annals of thoracic surgery, 103(2), 491-496.
II. Sousa AIC, Gonçalves AMGS, Madureira AJBS, Almeida JMS, Torres JMLP. Marked mitral prosthesis rocking motion preceding atrioventricular groove rupture. J Cardiol Cases. 2014 Oct 18;11(1):25-27. doi: 10.1016/j.jccase.2014.09.004. PMID: 30546529; PMCID: PMC6280011.
III. Raevsky E, Kwanten L, Cullen S, Stoica S. Repair of atrioventricular disruption after mitral valve replacement utilizing commando procedure principles. Interact.
IV. Kwon JT, Jung TE, Lee DH. The rupture of atrioventricular groove after mitral valve replacement in an elderly patient. J Cardiothorac Surg. 2014 Feb 8;9:28. doi: 10.1186/1749-8090-9-28. PMID: 24506935; PMCID: PMC3922257.
V. Cardiovasc Thorac Surg. 2022 Jul 9;35(2):ivac179. doi: 10.1093/icvts/ivac179. PMID: 35775927; PMCID: PMC9270861.
VI. Guerrero, A. F., Valero, W., Tavera, A., Obando, C. E., Camacho, J., & Giraldo, J. C. (2016). Atrioventricular disruption after mitral valve replacement reoperation: repair and echocardiographic evaluation. Revista Colombiana de Cardiología, 23(4), 333-e1.
VII. Antonic M, Djordjevic A, Mohorko T, Petrovic R, Lipovec R, Juric P. Left ventricular pseudoaneurysm following atrioventricular groove rupture after mitral valve replacement. SAGE Open Med Case Rep. 2019 Jan 12;7:2050313X18823456. doi: 10.1177/2050313X18823456. PMID: 30719310; PMCID: PMC6349977.
VIII. Durukan AB, Serter FT, Gurbuz HA, Tavlasoglu M, Ucar HI, Yorgancioglu C. Biological glue application in repair of atrioventricular groove rupture: a case report. J Tehran Heart Cent. 2014;9(3):137-9. Epub 2014 Jul 3. PMID: 25870633; PMCID: PMC4393838.
IX. Abel SA, Stark TA, Rehfeldt KH, Rihal CS, Said SM. Modified Cabrol Shunt for Atrioventricular Groove Rupture After Mitral Valve Replacement. Ann Thorac Surg. 2018 Jan;105(1):e11-e13. doi: 10.1016/j.athoracsur.2017.07.044. PMID: 29233353. (9 was made 8))
X. Chen, F., Wang, X., Zhuang, X. y Guo, H. (2022). Mitral anuloplasty with approach of left atrial atrial sulcus-dome in a patient with Marfan syndrome. Journal of Cardiothoracic Surgery, 17 (1), 293.
XI. Ciro Mancilha Murad and others, Late atrioventricular groove disruption presenting 7 years after mitral valve replacement: a case report, European Heart Journal - Case Reports, Volume 4, Issue 3, June 2020, Pages 1–5, https://doi.org/10.1093/ehjcr/ytaa091
XII. Karlson KJ, Ashraf MM, Berger RL. Rupture of left ventricle following mitral valve replacement. Ann Thorac Surg. 1988 Nov;46(5):590-7. doi: 10.1016/s0003-4975(10)64712-1. PMID: 3190341.