Department of Cardiology, Chiba-Nishi General Hospital, Matsudo, Japan.
Department of Cardiology, Cardiovascular Center, Showa General Hospital, Kodaira, Tokyo, Japan.
ESC Heart Fail. 2019 Apr;6(2):446-448. doi: 10.1002/ehf2.12415. Epub 2019 Feb 18.
Although aortic valve (AV) replacement is a curative procedure for severe aortic stenosis, prosthetic heart valves have many disadvantages and cause serious complications. A new promising surgical procedure-aortic valve neocuspidization (AVNeo)-has recently been developed; it is an original method of AV reconstruction with autologous pericardium. It has been reported to yield excellent medium-term results with respect to durability and complications. Herein, we encountered a first case of AV leaflet tear and perforations 27 months after AVNeo using autologous pericardium. AV leaflet tear or perforation is well recognized as a long-term serious complication of pericardial xenografts. Interestingly, however, AVNeo caused early structural valve deterioration in the current case. In the present case, an eccentric aortic regurgitation jet observed on colour flow imaging led us to reach the correct diagnosis. Finally, the patient showed complete recovery with redo AV replacement. This case highlights the importance of understanding the potential pitfalls of this new surgical technique and that of colour Doppler echocardiography in reaching a definite diagnosis.
虽然主动脉瓣（AV）置换术是治疗严重主动脉瓣狭窄的一种有治愈效果的方法，但人工心脏瓣膜有许多缺点，并会导致严重的并发症。最近，一种新的有前途的手术方法——主动脉瓣新生物成形术（AVNeo）已经被开发出来；这是一种使用自体心包的 AV 重建的原始方法。据报道，该方法在耐久性和并发症方面取得了优异的中期结果。在此，我们遇到了首例使用自体心包的 AVNeo 术后 27 个月出现 AV 瓣叶撕裂和穿孔的病例。AV 瓣叶撕裂或穿孔是公认的心包异种移植物的长期严重并发症。然而，有趣的是，AVNeo 在本病例中导致了早期的结构性瓣膜恶化。在本病例中，彩色血流成像上观察到偏心性主动脉瓣反流射流，促使我们做出正确的诊断。最终，患者通过再次进行 AV 置换完全康复。本病例强调了理解这种新手术技术的潜在陷阱以及彩色多普勒超声心动图在明确诊断中的重要性。
