Posterior wall disruption of the left ventricle after mitral valve replacement: management of bleeding and cardiac enlargement.

Two patients who underwent mitral valve replacement sustained posterior left ventricular disruption postoperatively and survived. Management consisted of repair from outside the heart without removal of the mitral prosthesis. This was achieved with a running Prolene suture in the atrioventricular junction in one patient and pledgeted sutures in the other who had transverse midventricular disruption. Biologic glue was crucial in controlling hemorrhage after the repair in both cases. The patient with transverse midventricular disruption required placement bilaterally of pectoralis muscle flaps to close the sternal wound because of swelling and dilatation of the heart.