Seo H, Sasaki Y, Hirai H, Hosono M, Sakaguchi M, Nagashima F, Nakahira A, Morisaki A, Okada Y, Suehiro S
Department of Cardiovascular Surgery, Osaka City University Graduate School, Osaka, Japan.
Kyobu Geka. 2011 May;64(5):415-8.
A 76-year-old woman with a history of severe mitral valve stenosis had undergone mitral valve replacement with a 27 mm St. Jude Medical (SJM) valve in 1991. Follow-up transthoracic echocardiography revealed an increase in the pressure gradient across the mitral prosthesis 16 years after the surgery. Prosthetic valve dysfunction was suspected, but transesophageal echocardiography and cineradiography failed to show mechanical valve dysfunction. Two years later, she presented with dyspnea on exertion and leg edema. Cineradiography revealed intermittent restriction of the opening of the mechanical valve leaflet approximately every 10 beats. Thus, we diagnosed intermittent prosthetic valve dysfunction and performed a reoperation. On inspection of the prosthesis, we observed semicircular pannus formation around the posterior leaflet in the ventricular side. It was considered that the pannus tissue had interfered with 1 leaflet opening of the mitral valve prosthesis, resulting in intermittent valve dysfunction. We replaced the prosthesis with a new 25 mm SJM valve. The patient was discharged after confirmation of normal prosthetic function.
一名76岁有严重二尖瓣狭窄病史的女性于1991年接受了二尖瓣置换术，植入了一枚27毫米的圣犹达医疗（SJM）瓣膜。术后16年的经胸超声心动图随访显示二尖瓣人工瓣膜两端的压力梯度增加。怀疑人工瓣膜功能障碍，但经食管超声心动图和电影造影均未显示机械瓣膜功能障碍。两年后，她出现劳力性呼吸困难和腿部水肿。电影造影显示机械瓣膜小叶开口大约每10次心跳出现间歇性受限。因此，我们诊断为间歇性人工瓣膜功能障碍并进行了再次手术。检查人工瓣膜时，我们观察到心室侧后叶周围有半圆形的血管翳形成。认为血管翳组织干扰了二尖瓣人工瓣膜的一个小叶开口，导致间歇性瓣膜功能障碍。我们用一枚新的25毫米SJM瓣膜替换了人工瓣膜。确认人工瓣膜功能正常后，患者出院。
