Yokokawa Tetsuro, Ohara Takahiro, Takashio Seiji, Sakamoto Mari, Wada Yuko, Nakamura Kenji, Takahama Hiroyuki, Amaki Makoto, Hasegawa Takuya, Sugano Yasuo, Kanzaki Hideaki, Yasuda Satoshi, Ogawa Hisao, Fujita Tomoyuki, Kobayashi Junjiro, Okamoto Yoko, Matsuyama Taka-Aki, Ishibashi-Ueda Hatsue, Anzai Toshihisa
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan.
Intern Med. 2016;55(5):479-83. doi: 10.2169/internalmedicine.55.5466. Epub 2016 Mar 1.
A 49-year-old man was admitted to our hospital with a chief complaint of dyspnea. He had a history of mitral valve replacement (MVR) with a Starr-Edwards (SE) caged-disc valve at the age of 14. Echocardiography revealed elevated trans-valvular pressure gradient of the mitral prosthetic valve with neither disk motion abnormality nor abnormal structure. Catheterization confirmed an elevation of the mean diastolic gradient of the mitral valve to 12.3 mmHg. Re-MVR was performed, and abnormal tissue attached to the cage of the valve and proliferating beneath the valve was observed. Histologic examination revealed them as fibrinous tissue and mild pannus proliferation, respectively. This rare case report focuses on long-term follow-up and the complication of a SE caged-disc valve. A SE caged-disc valve may become stenotic, only detected with a trans-valvular pressure gradient without any disk motion abnormality or abnormal structure during a prolonged follow-up period.
一名49岁男性因呼吸困难为主诉入院。他14岁时曾接受过二尖瓣置换术（MVR），植入了Starr-Edwards（SE）笼球瓣。超声心动图显示二尖瓣人工瓣膜跨瓣压差升高，瓣膜圆盘运动及结构均无异常。心导管检查证实二尖瓣平均舒张压差升高至12.3 mmHg。遂行再次二尖瓣置换术，术中观察到瓣膜笼架上附着有异常组织，且瓣膜下方有组织增生。组织学检查分别显示为纤维蛋白组织和轻度血管翳增生。本罕见病例报告重点关注SE笼球瓣的长期随访及并发症。在长期随访期间，SE笼球瓣可能会出现狭窄，仅通过跨瓣压差检测到，而瓣膜圆盘运动及结构均无异常。
