Chahal Mangeet, Pandya Utpal, Adlakha Satjit, Khouri Samer J
Division of Cardiovascular Medicine, University of Toledo, Toledo, Ohio 43614, USA.
Echocardiography. 2011 Aug;28(7):E146-8. doi: 10.1111/j.1540-8175.2011.01412.x. Epub 2011 Jul 13.
A 43-year-old woman, with a remote history of rheumatic mitral stenosis and a St. Jude prosthetic mitral valve replacement, presented with shortness of breath and palpitations, shortly after a long flight. On admission, atrial fibrillation with a rapid ventricular response was noted in the setting of a long history of noncompliance with her anticoagulation. Transesophageal echocardiography (TEE) demonstrated multiple laminated thrombi in the left atrial appendage. Live three-dimensional (3D) TEE confirmed this diagnosis and demonstrated an immobile posterior leaflet of the mitral prosthesis, which had direct implications in her management. She successfully underwent surgery for mitral valve replacement, left atrial appendage ligation, and a Maze procedure on the following day. The multiple thrombi within the atrial appendage were confirmed intraoperatively and pannus formation was determined to be the etiology of the leaflet immobility.
一名43岁女性，有风湿性二尖瓣狭窄及圣犹达人工二尖瓣置换术病史，在长途飞行后不久出现呼吸急促和心悸。入院时，在长期不遵守抗凝治疗的背景下，发现心房颤动伴快速心室反应。经食管超声心动图（TEE）显示左心耳内有多个分层血栓。实时三维（3D）TEE证实了这一诊断，并显示二尖瓣人工瓣膜后叶固定不动，这对她的治疗有直接影响。次日，她成功接受了二尖瓣置换术、左心耳结扎术和迷宫手术。术中证实心耳内有多个血栓，确定瓣叶固定不动的病因是血管翳形成。
