Ventricular septal defect following mitral valve replacement

Arriola-Montenegro et al. [1] present a rare but interesting complication post mitral valve replacement. The proposed explanations for the development of the ventricular septal defect are all reasonable, but a possible more probable one exists that was not presented, that has previously been described, caused by the strut of a mitral valve bioprosthesis [2].

A long membranous septum, as described, a narrow outflow tract, high prosthetic strut height, intraventricular prosthetic implantation and strut alignment such that it impinges the septum are all risk factors for a VSD to develop post-tissue mitral tissue valve replacement.

Of note the strut height of the mitral valve bioprosthesis used was low compared to other valves on the market [3]. The 3D geometry of the mitral valve has been previously commented on regarding indications and complications, but VSD was not described [4, 5].

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