Other Complications of Prosthetic Valves : 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 rupture:
1) At the insertion of papillary muscle due to over enthusiastic resection 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 than 75 per cent.