Faizal A, Umesan C V, Radhakrishnan N, Lakshmi V, Hemalatha R
Institute of Cardiovascular Diseases, Madras Medical Mission, Mogappair, Chennai, India.
J Heart Valve Dis. 2001 Nov;10(6):819-21.
Patients with rheumatic valvular heart disease who have undergone valve surgery may present later with progression of disease in other valves. We report a case of successful percutaneous transvenous mitral commissurotomy (PTMC) in a 58-year-old male who underwent aortic valve replacement (AVR) with a No. 23 Björk-Shiley valve for severe rheumatic aortic regurgitation in 1982. At AVR, echocardiography revealed mild mitral stenosis (MS) and mitral valve area (MVA) 2.5 cm2. Over 18 years, the mitral valve disease progressed to severe MS and the patient presented with class III exertional dyspnea. He underwent successful PTMC (Inoue balloon technique). Post-procedure echocardiography revealed a MVA of 2.0cm2 and grade II mitral regurgitation. Anticoagulation management, infective endocarditis prophylaxis and procedural modifications are discussed.
接受过瓣膜手术的风湿性心脏瓣膜病患者，后期可能会出现其他瓣膜疾病进展的情况。我们报告一例成功的经皮经静脉二尖瓣交界切开术（PTMC），患者为一名58岁男性，1982年因严重风湿性主动脉瓣反流接受了23号Björk-Shiley瓣膜主动脉瓣置换术（AVR）。在进行AVR时，超声心动图显示轻度二尖瓣狭窄（MS），二尖瓣面积（MVA）为2.5平方厘米。18年间，二尖瓣疾病进展为严重MS，患者出现Ⅲ级劳力性呼吸困难。他接受了成功的PTMC（Inoue球囊技术）。术后超声心动图显示MVA为2.0平方厘米，二尖瓣反流Ⅱ级。文中讨论了抗凝管理、感染性心内膜炎预防及手术改良。
