Koh Tat W, Gandhi Sandeep
Department of Cardiology, London Chest Hospital, United Kingdom.
J Am Soc Echocardiogr. 2002 Dec;15(12):1538-40. doi: 10.1067/mje.2002.128509.
The transesophageal echocardiographic assessment of prosthetic aortic valve function is made more difficult by the presence of a mechanical mitral valve prosthesis because echocardiographic views conventionally used to assess the aortic valve function are obscured by acoustic shadowing and artifacts. We report the use of intraoperative transesophageal echocardiography in a patient who developed severe prosthetic aortic valve regurgitation after implantation of a mechanical mitral valve, in whom conventional multiplane midesophageal views failed to reveal aortic regurgitation owing to acoustic shadowing and artifacts from the prosthetic mitral valve. We report the value of the deep transgastric long-axis view of the aortic valve that provided an unobstructed view of the left-ventricular outflow tract, and clearly demonstrated severe aortic regurgitation as a result of interference with the prosthetic aortic valve mechanism by the implanted mitral valve prosthesis. This case also emphasizes the importance of a comprehensive intraoperative transesophageal examination, including that of surrounding structures, to detect iatrogenic complications during mitral valve replacement.
人工机械二尖瓣假体的存在使经食管超声心动图对人工主动脉瓣功能的评估变得更加困难，因为传统上用于评估主动脉瓣功能的超声心动图视图会被声影和伪像遮挡。我们报告了术中经食管超声心动图在一名植入机械二尖瓣后发生严重人工主动脉瓣反流患者中的应用，在该患者中，由于人工二尖瓣产生的声影和伪像，传统的多平面中食管视图未能显示主动脉反流。我们报告了主动脉瓣的深胃长轴视图的价值，该视图提供了左心室流出道的无障碍视图，并清楚地显示了由于植入的二尖瓣假体干扰人工主动脉瓣机制而导致的严重主动脉反流。该病例还强调了术中进行全面经食管检查（包括对周围结构的检查）对于检测二尖瓣置换术中医源性并发症的重要性。
