Department of Radiology, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea.
Int J Cardiovasc Imaging. 2010 Feb;26 Suppl 1:169-72. doi: 10.1007/s10554-010-9587-2. Epub 2010 Jan 23.
Aortic regurgitation caused by leaflet perforation is most frequently seen in association with infective endocarditis that involves the aortic valve. There have been occasional reports of iatrogenic aortic regurgitation caused by aortic valve injury after cardiac surgery with the use of the transaortic approach or invasive cardiac procedures. Suture-related aortic valve injury can develop during periaortic cardiac surgery, but this has been very rarely reported. Inadvertent injury to an aortic valve leaflet caused by a stitching needle or surgical forceps can produce leaflet perforation with aortic regurgitation. This report describes a case of aortic regurgitation that was caused by iatrogenic aortic valve leaflet perforation, and this occurred in a 22-year-old woman who underwent repair of a ventricular septal defect (VSD) 15 years previously. Transthoracic echocardiography (TTE) showed a defect located at the aortic annulus close to the infundibular septum on a two-dimensional echocardiographic study and we observed an eccentric jet flow into the left ventricle in early diastole on the continuous wave and color flow Doppler studies. A small perforation in the body of the right aortic cusp and mild to moderate aortic regurgitation were confirmed by the use of transesophageal echocardiography (TEE) and ascending aortography.
瓣叶穿孔导致的主动脉瓣关闭不全最常与感染性心内膜炎相关，后者累及主动脉瓣。偶尔也有报道称，经升主动脉入路或有创性心脏手术使用心脏手术后发生医源性主动脉瓣关闭不全导致主动脉瓣损伤。在心脏手术的主动脉周围，可能会发生与缝合相关的主动脉瓣损伤，但这种情况非常罕见。主动脉瓣叶缝合针或手术器械的意外损伤可导致瓣叶穿孔和主动脉瓣关闭不全。本报告描述了一例医源性主动脉瓣叶穿孔导致的主动脉瓣关闭不全，患者为 22 岁女性，15 年前曾行室间隔缺损（VSD）修补术。经胸超声心动图（TTE）显示二维超声心动图检查时在靠近漏斗隔的主动脉瓣环处存在缺损，连续波和彩色多普勒研究显示舒张早期有偏心射流进入左心室。经食管超声心动图（TEE）和升主动脉造影证实右冠状动脉瓣体有小穿孔和轻至中度主动脉瓣关闭不全。
