[A successful repair of the left ventricular rupture and tracheo-esophageal fistula complicated after mitral valve replacement--a case report].

A 59-year-old woman having mitral stenosis with left atrial thrombus, was admitted to our department and uneventful mitral valve replacement was performed. After weaning from the cardiopulmonary bypass, massive pericardial bleeding was encountered and the heart soon arrested. CPB was reinstituted after thirty minutes. The diagnosis was the left ventricular rupture (Miller Type III), and the direct closure was successfully performed. The patient was complicated with renal and heart failures, which were well managed by the peritoneal dialysis and intraaortic balloon pumping. Long-term intratracheal intubation, however, was required due to the respiratory failure, and tracheostomy was done on the seventeenth postoperative day. The patient was also complicated with mediastinitis, the cause of which was considered to be the tracheo-esophageal fistula (TEF) diagnosed by esophagoscopy and bronchoscopy. Gastrostomy and continuous mediastinal lavage were performed but the TEF was not closed. Thus, the direct suture of the esophageal fistula orifice and the resection of four tracheal rings followed by the direct end-to-end anastomosis were performed on the 102nd postoperative day. After the second operation, the patient greatly improved, and was discharged eighty-seven days later, presenting only slight LV posterior wall hypokinesis but no tracheal stenosis.