Predisposing factors include resection of the posterior leaflet, overzealous decalcification of the annulus, insertion of an oversized prosthesis, and redo-mitral valve replacement (as was the case in this series), especially if the stent of a bioprosthesis has eroded the posterior ventricular wall.
Tania Rodriguez-Gabella, M.D., from Laval University in Quebec City, and colleagues examined postoperative echocardiographic data and clinical outcomes in consecutive patients (mean age, 72 years; 61.5 percent male) undergoing SAVR with a bioprosthesis between 2002 and 2004.
After uneventful replacement of his aortic valve with a 23 mm bioprosthesis (cross clamp time 56 min, cardiopulmonary bypass time 72 min) the patient was transferred to our intensive care unit sedated and intubated.
It is mostly due to anatomical factors including low coronary ostia and shallow sinuses of Valsalva (SOV) and with valve in valve (VIV) for surgical bioprosthesis. LM protection should be considered in LM height of less than 9 mm, a difference of less than 2 mm between the SOV mean diameter, and the prosthesis diameter or severe aortic valve calcifications with the presence of left cusp large bulky calcium nodule(s).