Yoshida Kazufumi, Fukunaga Naoto, Koizumi Shigeki, Nishiya Kenta, Matsuda Yasuhiro, Ishigami Masanosuke, Nagasawa Atsushi, Sakata Ryuzo, Koyama Tadaaki
Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan.
Kyobu Geka. 2017 Mar;70(3):177-180.
A 50-year-old man was admitted with fever and chill sensation 6 months ago. Transthoracic echocardiography (TTE) showed left and right coronary cusp prolapses and a thickened tissue of the aortic curtain. Congestive heart failure due to active infective aortic valve endocarditis was diagnosed, and he underwent aortic valve replacement. The aortic annulus was reconstructed using a glutaraldehydetreated autologous pericardium. Six months after surgery, TTE showed severe aortic regurgitation and saccular change in the aortic annulus. Transesophageal echocargiography showed some echo free space from left to noncoronary cusp and abnormal movement of the prosthetic valve annulus. Intraoperative examination showed dehiscence of the pericardial patch from the aortic wall, but no finding of infection. Aortic valve rereplacement was performed with reconstruction of the aortic annulus using a bovine pericardium. To prevent the dehiscence of the pericardial patch from the aortic wall, sutures fixing the prosthetic valve were passed from outside of the aortic wall.
一名50岁男性于6个月前因发热和寒战入院。经胸超声心动图（TTE）显示左、右冠状动脉瓣脱垂以及主动脉瓣叶增厚。诊断为活动性感染性主动脉瓣心内膜炎所致的充血性心力衰竭，他接受了主动脉瓣置换术。使用经戊二醛处理的自体心包重建主动脉瓣环。术后6个月，TTE显示严重主动脉瓣反流以及主动脉瓣环的囊状改变。经食管超声心动图显示从左冠状动脉瓣到无冠状动脉瓣有一些无回声区，以及人工瓣膜瓣环的异常运动。术中检查发现心包补片与主动脉壁分离，但未发现感染迹象。使用牛心包重建主动脉瓣环后再次进行主动脉瓣置换术。为防止心包补片与主动脉壁分离，将固定人工瓣膜的缝线从主动脉壁外侧穿过。
