Atrioventricular disruption after mitral valve replacement: the role of intraoperative transesophageal echocardiography
Wednesday, November 5, 2014
Anesth Analg. 2014 Nov;119(5):1074-7.
Atrioventricular disruption after mitral valve replacement: the role of intraoperative transesophageal echocardiography
Chui J, Roscoe A, Tsang W.
Clinician's Key Teaching Points
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Atrioventricular disruption is a rare but often fatal complication of mitral valve replacement resulting from excessive debridement of annular calcification, placement of annular sutures partially within the posterior left ventricular wall, or lifting the heart in a manner that uses the atrioventricular groove as a fulcrum.
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Although the initial transesophageal echocardiogram (TEE) findings may be nonspecific, it can help distinguish atrioventricular disruption from other complications of mitral replacement such as paravalvular leak or left atrial dissection. Isolated paravalvular regurgitation typically presents without adjacent hematoma. Left atrial dissection is characterized by an echolucent space within the atrial septum or lateral atrial wall that may demonstrate blood flow on Doppler imaging or systolic collapse of the space.
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In this case, besides identifying paravalvular regurgitation, TEE demonstrated an enlarging hematoma of the atrial septum and an increasing degree of prosthesis rocking indicative of partial separation of the sewing ring from the annulus. In addition, a progressive decline in biventricular systolic dysfunction was observed.
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Three-dimensional TEE may offer advantages over 2D imaging in the recognition of atrioventricular disruption. In particular, an en face view of the mitral prosthesis may demonstrate extensive separation of the sewing ring away from the annulus, distinguishing this condition from an isolated paravalvular leak.
© Written by Kent H. Rehfeldt, MD, Roman M. Sniecinski, MD, and Martin J. London, MD (2014 Nov, in Anesth Analg).
