Sezai Akira, Shiono Motomi, Hata Mitsumasa, Saito Akira, Hattori Tsutomu, Wakui Shinji, Soeda Masao, Kasamaki Yuji, Tokai Kohtaro, Saito Satoshi, Negishi Nanao, Sezai Yukiyasu
Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan.
Ann Thorac Cardiovasc Surg. 2005 Dec;11(6):413-5.
The Carpentier-Edwards pericardial bioprosthesis has been markedly improved in the long-term results and valve-related complications including valve dysfunction, compared to the previous generation bioprosthesis. We report a patient in whom transient prosthetic valve regurgitation and hemolysis occurred early after mitral valve replacement using a Carpentier-Edwards pericardial bioprosthesis and were resolved by preservative therapy. The patient was a 77-year-old female diagnosed with severe mitral valve stenosis and insufficiency. She underwent mitral valve replacement with a Carpentier-Edwards pericardial bioprosthesis. Opening and closing of the three leaflets looked good on intraoperative transesophageal echocardiography (TEE). The only prosthetic valve regurgitation was evident at the central region where the leaflets form coaptation, and no abnormal findings were seen. Serum lactate dehydrogenase (LDH) was decreased to 405 U/l after surgery. However, LDH again began to increase on the 3rd day after surgery and it increased to 1,830 U/l on the 14th day after surgery. Hemolytic urine was detected on 10th day after surgery. PVL was not detected, but moderate abnormal regurgitation from the outside of the stent pocket was detected on TEE. Revision of valve replacement was considered, but LDH thereafter to 393 U/l on 41st day after surgery. The TEE was repeated, and only a trace of central jet was detected without abnormal regurgitation, unlike the previous examination. The patient did not develop any complications thereafter and was discharged on 47th day after surgery. LDH was nearly normal at the time of discharge.
与上一代生物瓣膜相比，卡朋蒂埃-爱德华兹心包生物瓣膜的长期效果以及包括瓣膜功能障碍在内的瓣膜相关并发症已得到显著改善。我们报告了一名患者，该患者在使用卡朋蒂埃-爱德华兹心包生物瓣膜进行二尖瓣置换术后早期出现了短暂的人工瓣膜反流和溶血，并通过保守治疗得以解决。该患者为一名77岁女性，被诊断为重度二尖瓣狭窄和关闭不全。她接受了卡朋蒂埃-爱德华兹心包生物瓣膜二尖瓣置换术。术中经食管超声心动图（TEE）显示三叶瓣的开闭良好。仅在瓣叶形成贴合的中央区域可见明显的人工瓣膜反流，未见异常发现。术后血清乳酸脱氢酶（LDH）降至405 U/l。然而，术后第3天LDH再次开始升高，术后第14天升至1830 U/l。术后第10天检测到血尿。未检测到人工瓣膜瓣周漏（PVL），但TEE检测到支架袋外部有中度异常反流。考虑进行瓣膜置换术翻修，但术后第41天LDH降至393 U/l。重复进行TEE检查，与之前的检查不同，仅检测到微量中央血流信号，无异常反流。此后患者未出现任何并发症，并于术后第47天出院。出院时LDH接近正常。
