Dissecting Intramyocardial Hematoma Following Mitral Valve Repair

Clinical Image

Ann Surg Perioper Care. 2022; 7(1): 1051.

Dissecting Intramyocardial Hematoma Following Mitral Valve Repair

Yalcin EK1, Villiers PD2, Wierup P3 and Alfirevic A1,2*

¹Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA

²Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH, USA

³Department of Cardiothoracic Surgery, Lund University, Lund, Sweden

*Corresponding author: Alfirevic A, Department of Outcomes Research, Cleveland Clinic, J4-274, 9500 Euclid Avenue, Cleveland, OH, USA

Received: August 24, 2022; Accepted: September 20, 2022; Published: September 27, 2022

Clinical Image

A 67-year-old male patient with a severe mitralinsufficiency presented for reoperation after a failed Mitral Valve (MV) repair. The prior annuloplasty ring was removed and a new 32-mm fully rigid ring was inserted with the affixation of artificial chords to the anterior MV leaflet. Initial post-bypass transesophageal echocardiographic examination demonstratedresolution of mitral regurgitation and normal biventricular function (Figure 1), RV=Right Ventricle, LV=Left Ventricle).

Figure 1: 

    

    
    

    

    Figure 1:

Minutes later, reevaluation of the left ventricle in a transgastric view demonstrated large, dissecting intramyocardial hematomaspanning the entire lateral Left Ventricular (LV) wall (Figure 2). The myocardial LV free wall had aheteroechogenic, ovoid-shaped appearance with areas of neocavitation containing pulsatile flow (Figure2-A) and partial thrombosis (Figure2-B). Endomyocardial tissue bordered the neocavitation circumferentially (Figure 2-C) with no visible entry point.

Figure 2: 

    

    
    

    

    Figure 2:

Overall systolic function remained adequate despite significant mass-related wall motion abnormality. Ultimately, the hematoma stabilized after heparin reversal and follow-up transthoracic echocardiographic examination demonstrated slightly decreased size and more consolidation. Although unclear, iatrogenic injury during annuloplasty ring removal or re-suturing might be possible etiologies of dissecting intramyocardial hematoma.

Citation: Yalcin EK, Villiers PD, Wierup P and Alfirevic A. Dissecting Intramyocardial Hematoma Following Mitral Valve Repair. Ann Surg Perioper Care. 2022; 7(1): 1051.