Ono K, Kitamura N, Otaki M, Tamura H, Yamaguchi A, Miki T
Department of Cardiovascular Surgery, Osaka National Hospital, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1991 Sep;39(9):1809-12.
Acquired left ventricular-right atrial shunt is a very rare cardiac disease. Infective endocarditis, cardiac operative procedures, and thoracic trauma were reported as origins. We report a case of a patient with left ventricular-right atrial shunt due to infective endocarditis. A 53-year-old male who had aortic regurgitation due to infective endocarditis developed suddenly severe congestive heart failure. Two-dimensional and pulsed doppler echocardiography demonstrated left ventricular-right atrial shunt. Emergency operation was done. The fistula was found through the atrioventricular membranous septum. The position from the left view was just below the commissure between the right coronary cusp and non coronary cusp and the opening position from the right view was just above the septal leaflet of tricuspid valve. Aortic valve replacement and direct closure of fistula were done and patient's recovery was uneventful. Case reports of left ventricular-right atrial shunt due to infective endocarditis have been rarely seen, most of which were followed by poor prognosis. Surgical intervention in acute phase is recommended.
获得性左心室-右心房分流是一种非常罕见的心脏疾病。感染性心内膜炎、心脏手术操作和胸部创伤被报道为其病因。我们报告一例因感染性心内膜炎导致左心室-右心房分流的患者。一名53岁男性因感染性心内膜炎患有主动脉瓣反流，突然发生严重的充血性心力衰竭。二维和脉冲多普勒超声心动图显示左心室-右心房分流。进行了急诊手术。瘘管通过房室膜性间隔发现。从左视图看，其位置恰好在右冠状动脉瓣叶与无冠状动脉瓣叶之间的交界下方，从右视图看，开口位置恰好在三尖瓣隔叶上方。进行了主动脉瓣置换和瘘管直接闭合，患者恢复顺利。因感染性心内膜炎导致左心室-右心房分流的病例报告很少见，其中大多数预后不良。建议在急性期进行手术干预。
