An 80-Year-Old Man with Inferior Wall Myocardial Infarction and Cardiogenic Shock: Case Report.

We report a case of ruptured head of posteromedial papillary muscle and prolapse of anterior mitral valve leaflet that caused severe mitral regurgitation (MR) and cardiogenic shock as a complication of inferior wall myocardial infarction in an 80-year-old man. Emergency coronary angiogram revealed thrombotic occlusion at proximal right coronary artery. Transesophageal echocardiogram revealed ruptured head of posteromedial papillary muscle and prolapse of anterior mitral valve leaflet causing severe MR. After percutaneous coronary intervention with bare metal stent, the patient underwent mitral valve repair with saphenous vein graft to the posterolateral branch of the right coronary artery. The patient was discharged from hospital on day 14 of admission.

Concomitant Gerbode-like defect and anterior mitral leaflet perforation after aortic valve replacement for endocarditis.

We present a case of concomitant left ventricle (LV) to right atrial shunt (Gerbode-like defect) and anterior mitral leaflet perforation in a 32-year-old male after aortic valve replacement for infective endocarditis of bicuspid aortic valve. This case emphasises that intra-operative transesophageal echocardiography is a sine qua non for valvular surgical procedures.

Inferior Vena Cava Filter Broken and Migrated to Left Ventricle With Destruction of Mitral Valve.

Inferior vena cava filters are used for patients with pulmonary embolism or those with risk of embolization. Here we present a case of a 38-year-old man who underwent placement of an inferior vena cava filter because of deep vein thrombosis. The operating arm fractured and embolized to the posteromedial papillary muscle of mitral valve and the posterior inferior wall of the left ventricle through right atrium and atrioventricular septum, leading to large symptomatic mitral and tricuspid insufficiency and pericardial tamponade. Here we report a rare case where the filter migrated to the left ventricle and destroyed the mitral valve.

Mitral paravalvular abnormal tunnel with mitral regurgitation caused by anterior chest trauma.

We here present the case of a 35-year-old man with mitral valve paravalvular abnormal tunnel with mitral regurgitation caused by anterior chest trauma. The abnormal tunnel is between left ventricular and left artrial. We sutured the tunnel with a patch from the left atrial side. Meanwhile, we performed the mitral valve annuoplasty because of the mitral regurgitation accompanied. The postoperation and the 12th month follow up were uneventful.

Malpositioning of a pacemaker lead to the left ventricle accompanied by posterior mitral leaflet injury.

There have been several reports of a malpositioned pacemaker lead as a complication in pacemaker implantation. Herein we report a rare case of a malpositioned pacemaker lead in the left ventricle, which could occur in patients with cardiac structural abnormalities. A 70-year-old woman, who had undergone implantation of a pacemaker at the left subclavian position for complete atrioventricular block five years previously, was evaluated because of dyspnea and low grade fever. Echocardiography revealed a congenital atrial septal defect through which the lead was placed into the left ventricle. Whereas percuteneous lead removal seemed to be full of risk with concerns of thromboembolic events and infective endocarditis, the patient was referred to our hospital for surgical removal of the wire and closure of the defect. The lead was a screw-in type and removed and was extracted in the theatre using radiography. Intraoperatively it was found that the lead was positioned in the left ventricle apex after perforating the posterior mitral leaflet. Repair of the mitral valve perforation and closure of the septal defect and epicardial pacemaker lead implantation was performed. This case demonstrated the possibility of malposition of the pacemaker lead to the left ventricle in a transvenous pacemaker implantation procedure, which may lead to thromboembolic complication or infective endocarditis, and the pre-eminent role of echocardiography in the diagnosis of cardiac structural abnormalities. A malpositioned pacemaker lead in the left ventricle is a rare complication that can occur in patients with cardiac structural abnormalities. Lateral chest roentgenogram and echocardiography is efficient in preventing this complication. The removal of the lead in concerns of thromboembolic events and infection is preferable.

Repair of isolated mitral papillary muscle rupture consequent to blunt trauma in a small child.

Blunt thoracoabdominal trauma is most often caused by high-velocity motor-vehicle accidents or by falls from a height. The clinical spectrum of cardiac injuries arising from this type of trauma varies from myocardial contusion to valvular rupture. Intracardiac valvular rupture is rarely observed, and few cases have been reported. The youngest of the patients in cases reported to date was 6 years of age. Here we report the case of a 2(1/2)year-old child, who sustained mitral valve insufficiency due to isolated rupture of the posterior mitral papillary muscle, which developed after a domestic accident.

Iatrogenic perforation of the posterior mitral valve leaflet: a rare complication of pacemaker lead placement.

An inadvertently placed pacing lead in the left ventricle (LV) is a rare and often underdiagnosed complication of pacemaker implantation. We present a case of a 73-year-old woman who was evaluated for dyspnea, 10 years after transvenous pacemaker implantation. Transthoracic and transesophageal echocardiography revealed a secundum atrial septal defect through which the ventricular pacing lead was placed into the LV. Whereas percutaneous extraction of the lead seemed too full of risk, the patient was referred for surgical removal of the wire and closure of the defect. Intraoperatively it was found that the lead had perforated the posterior mitral valve leaflet before it was positioned into the LV apex. Therefore, the wire could only be partially removed during surgery and two lead fragments remained in the LV for which anticoagulation therapy was initiated. This case demonstrates the pre-eminent role of echocardiography in the diagnosis of cardiac structural abnormalities.

Plastia da valva mitral / Valvoplasty mitral

A abordagem cirúrgica conservadora da valva mitral é amplamente analisada nesta monografia. A plastia mitral, cada vez mais, se estabelece como tratamento de primeira escolha para a regurgitação mitral de qualquer etiologia. O crescimento dessa aceitação deve-se à superioridade da plastia mitral em termos de morbidade e mortalidade quando comparada aos substitutos valvares, fato esse amplamente respaldado pela literatura. Ao rever brevemente o histórico da plastia mitral, percebemos a importância de Carpentier e a atualidade de suas contribuições tão originais, bem como a visão de longo alcance e a proximidade com o método cintífico de Cosgrove...