Futami Munetomo, Kuroda Masahiko, Kawamoto Masashi
Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima 734-8551.
Masui. 2010 May;59(5):635-40.
We treated a patient with severe mitral regurgitation associated with systolic anterior motion of the mitral valve that occurred after aortic valve replacement and a myectomy for aortic stenosis and hypertrophic obstructive cardiomyopathy. A 76-year-old woman with aortic stenosis and hypertrophic obstructive cardiomyopathy underwent aortic valve replacement and a myectomy. Following these procedures, transesophageal echocardiography showed severe mitral regurgitation associated with systolic anterior motion. Neither adequate volume loading nor beta-blocker administration was effective for improvement of the systolic anterior motion, but vasoconstrictor administration was effective. We also performed mitral valve replacement. To the best of our knowledge, this is the first reported case of intraoperative management following aortic valve replacement and myectomy for aortic stenosis complicated with hypertrophic obstructive cardiomyopathy. Transesophageal echocardiography was very useful for intraoperative assessment and developing a strategy for improving severe mitral regurgitation.
我们治疗了一名严重二尖瓣反流患者，该反流与二尖瓣收缩期前向运动有关，此情况发生在主动脉瓣置换及因主动脉瓣狭窄和肥厚型梗阻性心肌病行室间隔心肌切除术后。一名患有主动脉瓣狭窄和肥厚型梗阻性心肌病的76岁女性接受了主动脉瓣置换和室间隔心肌切除术。术后，经食管超声心动图显示严重二尖瓣反流并伴有收缩期前向运动。增加血容量及使用β受体阻滞剂均无法有效改善收缩期前向运动，但使用血管收缩剂有效。我们还进行了二尖瓣置换术。据我们所知，这是首例关于主动脉瓣狭窄合并肥厚型梗阻性心肌病行主动脉瓣置换及室间隔心肌切除术后术中管理的报道病例。经食管超声心动图对术中评估及制定改善严重二尖瓣反流的策略非常有用。
