Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
Cardiovasc Pathol. 2019 Jul-Aug;41:8-10. doi: 10.1016/j.carpath.2019.03.003. Epub 2019 Apr 1.
Acute aortic root thrombosis extended to coronary ostia is a rare but potentially life-threatening complication of aortic valve replacement with bioprosthetic substitutes. We aimed to present the case of a 72-year-old woman with symptomatic rheumatic valve disease and associated atrial fibrillation who underwent conventional mitroaortic valve replacement with two stented bioprostheses (pericardial and porcine, respectively). Eight days after surgery, she had cardiac arrest due to ventricular fibrillation, requiring immediate cardiopulmonary resuscitation. Left ventricle akinesia by echocardiography and troponin levels up to 35,000 ng/L pointed to coronary ischemia. Emergent coronary angiography showed a subocclusion of the left main trunk, with the suspicion of aortic root thrombosis. The patient was immediately reoperated, fresh thrombi were removed from the aortic root, and the aortic Magna Ease 21-mm bioprosthesis was replaced with a stentless Solo Smart 21-mm bioprosthesis. The patient died of septic complications.
急性主动脉根部血栓延伸至冠状动脉口是生物瓣替换主动脉瓣置换术的一种罕见但潜在危及生命的并发症。我们旨在介绍一位 72 岁女性的病例，该女性患有有症状的风湿性瓣膜病和相关的心房颤动，接受了常规的二尖瓣主动脉瓣置换术，使用了两个支架生物瓣（分别为心包和猪）。术后 8 天，她因室颤导致心脏骤停，需要立即进行心肺复苏。超声心动图显示左心室无运动和肌钙蛋白水平高达 35,000ng/L，提示存在冠状动脉缺血。紧急冠状动脉造影显示左主干次闭塞，怀疑主动脉根部血栓形成。患者立即接受再次手术，从主动脉根部清除了新鲜血栓，并使用无支架 Solo Smart 21 毫米生物瓣替换了 Magna Ease 21 毫米生物瓣。患者死于感染性并发症。
