Shimazu A, Ishikura Y, Odagiri S, Hashimoto M, Hirao D, Shirakusa T
Department of Thoracic and Cardiovascular Surgery, School of Medicine, University of Occupational & Environmental Health, Kita-Kyushu, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1991 Jun;39(6):952-5.
We report a rare case of mitral stenosis associated with cardiac sarcoidosis and left ventricular aneurysm. A 60-year-old female was admitted with complaint of palpitation and dyspnea on exertion. Chest X-ray revealed cardiomegaly and pericardial calcification, but no bilateral hilar lymphadenopathy. Electrocardiogram showed various arrhythmia. Coronary angiography showed no stenosis in any coronary arteries. Cardioangiogram showed left ventricular aneurysm at the apex and mitral stenosis. Laboratory findings showed no evidence of sarcoidosis. Open mitral commissurotomy and left ventricular aneurysmectomy was performed. Pathological findings of the myocardium showed a remarkable degenerative change and a granulomatous inflammation. Postoperative biopsied specimens of right scalene lymph nodes revealed sarcoid reaction. The postoperative course was satisfactory, but arrhythmia remained. The patient was treated with steroids and pacemaker implantation. She has been doing well for 2 year postoperatively. An operative case of mitral stenosis associated with cardiac sarcoidosis and ventricular aneurysm due to sarcoidosis is very rare and the prognosis in patient is very poor usually.
我们报告一例罕见的二尖瓣狭窄合并心脏结节病及左心室室壁瘤病例。一名60岁女性因劳力性心悸和呼吸困难入院。胸部X线显示心脏扩大及心包钙化，但无双侧肺门淋巴结肿大。心电图显示多种心律失常。冠状动脉造影显示任何冠状动脉均无狭窄。心血管造影显示心尖部左心室室壁瘤及二尖瓣狭窄。实验室检查结果未显示结节病证据。实施了二尖瓣直视交界切开术及左心室室壁瘤切除术。心肌病理检查结果显示有显著的退行性改变及肉芽肿性炎症。术后右斜角肌淋巴结活检标本显示有结节病反应。术后病程顺利，但心律失常仍存在。患者接受了类固醇治疗及起搏器植入。术后2年来她情况良好。二尖瓣狭窄合并心脏结节病及结节病所致心室壁瘤的手术病例非常罕见，患者的预后通常很差。
