Uchikawa S, Ito Y, Hayashi K, Muramatsu T, Tsukahara R
Department of Cardiovascular Surgery, Kawasaki Social Insurance Hospital, Kawasaki, Japan.
Kyobu Geka. 2004 Feb;57(2):123-6.
A 50-year-old man with a heart murmur from early childhood and a one year history of general fatigue was admitted. Cardiac examination showed a left ventricular-right atrial (LV-RA) communication, and aortic and mitral valve regurgitation (III/IV). At surgery, the LV-RA communication was located in the atrioventricular membranous portion 3 mm above the septal leaflet of the tricuspid valve. The etiology of the LV-RA communication was congenital and valvular diseases were acquired changes caused by sclerosis due to infected endocarditis or hypertension. The diameter of the LV-RA communication defect was 6 mm, and the fibrous tissue around the defect was closed directly. Next, double-valve replacement was performed safely. However, the day after surgery, the patient developed complete atrioventricular block and implantation of a DDD pacemaker was required. He was discharged without other complication. We recommend the careful closure of the LV-RA communication defect, if the defect is small and rich in fibrous tissue.
一名50岁男性自幼患有心脏杂音，并有一年全身乏力病史，入院治疗。心脏检查显示存在左心室-右心房（LV-RA）交通，以及主动脉瓣和二尖瓣反流（III/IV级）。手术中，LV-RA交通位于三尖瓣隔叶上方3毫米处的房室膜部。LV-RA交通的病因是先天性的，而瓣膜疾病是由感染性心内膜炎或高血压导致的硬化引起的后天性改变。LV-RA交通缺损的直径为6毫米，缺损周围的纤维组织直接进行了闭合。接下来，安全地进行了双瓣膜置换术。然而，术后第二天，患者出现了完全性房室传导阻滞，需要植入DDD起搏器。他出院时没有其他并发症。如果LV-RA交通缺损较小且纤维组织丰富，我们建议仔细闭合该缺损。
