Nishiwaki N, Kawano Y, Nakayama Y, Takahashi H
Department of Cardiovascular Surgery, Fukuoka Tokushukai Hospital, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1992 Sep;40(9):1773-7.
We experienced a case of 51-year-old woman who underwent emergency aortic valve replacement by translocation method for active infective aortic valve endocarditis with aortic root abscesses. Postoperative course was complicated as the following. Three days later, the perforation of noncoronary sinus of Valsalva into the right atrium was noted and she developed progressive heart failure due to the massive left-to-right shunt. The second operation was performed immediately for the patch closure of the perforation through the right atriotomy. Two months later, unstable angina appeared because of the stenosis of the vein graft to the left coronary artery, leading to the emergency third operation in which LITA was placed to the left anterior descending artery. In spite of these complications she recovered gradually and she was discharged 6 months after the first operation. She is now doing well in NYHA class 2. Translocation method is quite useful for such a case of the aortic valve endocarditis with periannular abscesses in whom conventional valve replacement is supposed to be impossible, but the long durability of this type of the repair is unknown. Careful follow-up of the patient is mandatory.
我们遇到一例51岁女性，因活动性感染性主动脉瓣心内膜炎合并主动脉根部脓肿，通过移位法接受了急诊主动脉瓣置换术。术后病程出现了以下并发症。术后三天，发现瓦尔萨尔瓦非冠状动脉窦穿孔进入右心房，由于大量左向右分流，她出现了进行性心力衰竭。立即通过右心房切开术进行了第二次手术，用补片封闭穿孔。两个月后，由于左冠状动脉静脉移植物狭窄出现不稳定型心绞痛，导致进行急诊第三次手术，将左内乳动脉移植到左前降支。尽管出现了这些并发症，她仍逐渐康复，并在第一次手术后6个月出院。她目前纽约心脏协会心功能分级为2级，情况良好。移位法对于这种伴有瓣周脓肿的主动脉瓣心内膜炎病例非常有用，而传统的瓣膜置换术在此类病例中被认为是不可能的，但这种修复方式的长期耐久性尚不清楚。对患者进行仔细的随访是必要的。
