Department of Cardiovascular Surgery, Uji Tokushukai Medical Center, Uji City, Kyoto, Japan.
Cardiovasc Diagn Ther. 2014 Jun;4(3):267-9. doi: 10.3978/j.issn.2223-3652.2014.06.07.
A 74-year-old woman with a history of myocardial infarction and severe rheumatoid arthritis on immunosuppressants was referred to our hospital because of nausea and tooth pain, but no abnormalities were detected on physical or laboratory examination. Two weeks after the first assessment, she was referred to our hospital again because of tooth pain and dyspnea. Her echocardiogram showed severe aortic regurgitation, which was not detected at the assessment 2 weeks previously. After the patient's congestive heart failure showed improvement, she underwent aortic valve replacement; the aortic valve leaflets were severely shrunken and thickened, without any evidence of endocarditis. Pathological examination of the leaflets showed infiltration of inflammatory cells into the valve leaflets. Therefore, rheumatoid arthritis needs to be considered as an important risk factor for acute valvular disease.
一位 74 岁的女性，既往有心肌梗死病史，目前正在服用免疫抑制剂治疗严重类风湿关节炎，因恶心和牙痛就诊于我院，但体格检查和实验室检查均未见异常。首次评估后 2 周，她因牙痛和呼吸困难再次就诊于我院。其超声心动图显示严重主动脉瓣反流，而 2 周前的评估中并未发现该情况。在患者充血性心力衰竭得到改善后，她接受了主动脉瓣置换术；主动脉瓣叶严重皱缩和增厚，没有任何心内膜炎的证据。瓣叶的病理学检查显示炎性细胞浸润到瓣叶中。因此，类风湿关节炎需要被考虑为急性瓣膜病的一个重要危险因素。
