Seki Tatsuya, Shingu Yasushige, Wakasa Satoru, Katoh Hiroki, Ooka Tomonori, Tachibana Tsuyoshi, Kubota Suguru, Matsui Yoshiro
Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan.
Emergency and Critical Care Center, Hokkaido University Hospital, Sapporo, Japan.
J Artif Organs. 2019 Jun;22(2):177-180. doi: 10.1007/s10047-018-1086-6. Epub 2019 Jan 2.
Transvalvular leakage (TVL) of a prosthetic heart valve is not negligible regurgitant flow in patients with critically low contractile function. Although the opening function of prosthetic valves has been reported, its closing function is not well understood. A man in his 70 s had a history of mitral valve replacement (MVR) with a Magna Mitral® valve for ischemic mitral valve regurgitation. He presented with dyspnea 2 years postoperatively. Echocardiography showed moderate TVL. The pulmonary capillary wedge pressure and cardiac index were 37 mmHg and 1.65 L/min/m, respectively. Because we considered his TVL relevant, we performed re-do MVR with a mechanical valve and papillary muscle approximation and suspension ("papillary muscle tugging approximation"). His cardiac function improved postoperatively; he was discharged with New York Heart Association class I. For MVR in patients with critically low contractile function, prosthetic valves, such as mechanical valves, with small TVL are recommended.
对于收缩功能严重低下的患者，人工心脏瓣膜的跨瓣反流（TVL）是不可忽视的反流。虽然人工瓣膜的开放功能已有报道，但其关闭功能尚未得到充分了解。一名70多岁男性有因缺血性二尖瓣反流行二尖瓣置换术（MVR）并植入麦格纳二尖瓣（Magna Mitral®）瓣膜的病史。他术后2年出现呼吸困难。超声心动图显示中度TVL。肺毛细血管楔压和心脏指数分别为37 mmHg和1.65 L/min/m²。由于我们认为他的TVL与之相关，我们使用机械瓣膜并进行乳头肌拉近和悬吊（“乳头肌牵拉拉近”）再次行MVR。他术后心功能改善；出院时纽约心脏协会心功能分级为I级。对于收缩功能严重低下的患者行MVR，推荐使用TVL小的人工瓣膜，如机械瓣膜。
