Gillinov A Marc, Smedira Nicholas G, Shiota Takahiro
Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Ann Thorac Surg. 2004 Dec;78(6):e92-3. doi: 10.1016/j.athoracsur.2004.03.089.
A 68-year-old woman with concentric left ventricular hypertrophy, prosthetic valve endocarditis with aortic root abscess, and sepsis had aortic root replacement with an aortic allograft. On weaning from cardiopulmonary bypass, she had hemodynamic instability caused by systolic anterior motion of the mitral valve, which resulted in a left ventricular outflow tract obstruction; the peak pressure gradient across the left ventricular outflow tract was 130 mm Hg, and there was moderately severe (3+) mitral regurgitation. After reinstitution of cardiopulmonary bypass, a central Alfieri edge-to-edge stitch was placed between the anterior and posterior leaflets of the mitral valve. This reduced the gradient across the left ventricular outflow tract to 10 mm Hg and eliminated the mitral regurgitation, which enabled successful separation from cardiopulmonary bypass.
一名68岁女性，患有左心室向心性肥厚、人工瓣膜心内膜炎伴主动脉根部脓肿及脓毒症，接受了主动脉同种异体移植的主动脉根部置换术。在脱离体外循环时，她因二尖瓣收缩期前移导致血流动力学不稳定，进而造成左心室流出道梗阻；左心室流出道的峰值压力梯度为130 mmHg，存在中度严重（3+）的二尖瓣反流。重新建立体外循环后，在二尖瓣前后叶之间放置了一个中心Alfieri缘对缘缝合。这使左心室流出道的压力梯度降至10 mmHg，并消除了二尖瓣反流，从而得以成功脱离体外循环。
