1 Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Pulm Circ. 2013 Sep;3(3):696-9. doi: 10.1086/674330. Epub 2013 Dec 6.
Abstract A 33-year-old female patient with advanced idiopathic pulmonary artery hypertension underwent bilateral lung transplantation. The postsurgical course was complicated by prolonged mechanical ventilation and acute hypoxemia with recurrent episodes of pulmonary edema. An echocardiogram revealed improved right-sided pressures along with a dilated left atrium, a structurally normal mitral valve, and a new posterior-oriented severe mitral regurgitation. The patient's condition improved after treatment with arterial vasodilators and diuretics, and she has remained in World Health Organization functional class I after almost 36 months of follow-up. We hypothesize that cardiac ventricle remodeling and a geometric change in mitral valve apparatus after transplantation led to the hemodynamic changes and recurrent pulmonary edema seen in our patient. Our case is, to our knowledge, the second report of severe valvular regurgitation in a structurally normal mitral valve apparatus in the postoperative period and the first of a patient to be treated without valve replacement.
摘要 一名 33 岁的女性晚期特发性肺动脉高压患者接受了双肺移植。术后过程复杂，需要长时间机械通气，并且反复出现急性低氧血症和肺水肿。超声心动图显示右侧压力改善，同时左心房扩大，二尖瓣结构正常，出现新的后向严重二尖瓣反流。患者在使用动脉血管扩张剂和利尿剂治疗后病情改善，近 36 个月的随访后，她的情况仍处于世界卫生组织功能 I 级。我们假设移植后心脏心室重构和二尖瓣装置的几何形状变化导致了我们患者的血流动力学变化和反复肺水肿。据我们所知，我们的病例是术后结构正常的二尖瓣装置出现严重瓣膜反流的第二例报告，也是首例无需瓣膜置换治疗的病例。
