Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
J Am Soc Echocardiogr. 2011 Feb;24(2):228.e1-2. doi: 10.1016/j.echo.2010.06.022. Epub 2010 Jul 21.
A 45-year-old woman with a history of rheumatic mitral disease underwent valve replacement. After surgery, the patient became hemodynamically unstable. A transesophageal echocardiogram showed an underfilled left ventricle with a clot impinging on the lateral aspect of the left ventricle and a malfunctioning mitral valve prosthesis. After evacuation of the clot in the operating room, the mitral valve prosthesis began functioning normally. The prosthesis malfunction resulted from external cardiac compression. This dynamic device malfunction was replicated when the surgeon compressed the lateral aspect of the heart. To our knowledge, this dynamic form of leaflet dysfunction from external compression has not been described. This case highlights the importance of closely evaluating prosthetic valve function in the setting of hemodynamic deterioration.
一位 45 岁的女性，有风湿性二尖瓣疾病病史，接受了瓣膜置换手术。手术后，患者血流动力学不稳定。经食管超声心动图显示左心室充盈不足，有血栓撞击左心室外侧，二尖瓣假体功能障碍。在手术室清除血栓后，二尖瓣假体开始正常工作。假体功能障碍是由于心脏外部受压所致。当外科医生按压心脏外侧时，可复制出这种动态装置功能障碍。据我们所知，这种由于外部压迫导致的瓣叶动态功能障碍形式尚未被描述过。该病例强调了在血流动力学恶化的情况下密切评估假体瓣膜功能的重要性。
