Ribas Garau M, Pons Lladó G J, Forteza Albertí J F, Berna Martínez A, Merino Otermín A, Bonnín Gubianas J O, Barril Baixeras R
Servicio de Cardiología, Clínica Femenía, Palma de Mallorca.
Rev Esp Cardiol. 1999 Feb;52(2):145-7. doi: 10.1016/s0300-8932(99)74885-2.
The case of a patient with mitral and aortic mechanical valve prostheses is presented who developed early postoperative infective endocarditis and, subsequently, a fistulous communication between the posterior aortic sinus and both the left atrium and the left ventricle. A diastolic murmur of apparent aortic prosthesis regurgitation was heard, although an abnormal aortic valve function could not be demonstrated in the transthoracic echocardiographic study. Instead, the presence of a systolic high velocity flow by continuous wave Doppler suggested prosthetic mitral leakage. The clinical presentation of progressive congestive heart failure and pulmonary hypertension by Doppler prompted a further study by means of transesophageal echocardiography with multiplanar probe showing the above mentioned double fistulous communication. The diagnosis was later confirmed by angiography and also at surgery.
本文报告了一例二尖瓣和主动脉瓣机械瓣膜置换术后患者，该患者术后早期发生感染性心内膜炎，随后后主动脉窦与左心房和左心室之间出现瘘管交通。尽管经胸超声心动图检查未显示主动脉瓣膜功能异常，但听到了明显的主动脉人工瓣膜反流的舒张期杂音。相反，连续波多普勒显示的收缩期高速血流提示人工二尖瓣漏。多普勒检查提示进行性充血性心力衰竭和肺动脉高压的临床表现促使通过多平面探头经食管超声心动图进一步检查，显示上述双瘘管交通。后来通过血管造影及手术证实了诊断。
