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机械心脏瓣膜患者发生脑部金属栓子:一种极其罕见的并发症。

Metallic embolus to the brain in a patient with mechanical heart valves: an extremely rare complication.

作者信息

Sagheer Shazib, Sheikh Abu Baker, Hallstrom Jon J, Raizada Veena

机构信息

Internal Medicine, University of New Mexico Hospital, Albuquerque, New Mexico, USA.

Neuroradiology, University of New Mexico Hospital, Albuquerque, New Mexico, USA.

出版信息

BMJ Case Rep. 2019 Aug 1;12(8):e230653. doi: 10.1136/bcr-2019-230653.

Abstract

A 46-year-old man with a medical history of rheumatic valve disease underwent mitral and aortic valve replacements with On-X and CarboMedics Top Hat supra-annular mechanical valves, respectively. Seven months after the valve replacement surgery, the patient presented with dizziness. A CT scan of the brain was done as part of a thorough workup of dizziness. The CT scan revealed a small metallic density in the M2 branch of the right middle cerebral artery. The metallic density was believed to be a metallic embolus that originated from the mechanical valves or the suturing material, that is, Cor-Knot fastener. Although in our case, the dizziness was believed to be the result of benign paroxysmal positional vertigo, through this case, we aim to highlight this extremely rare structural complication of mechanical valves. This complication can have serious and potentially fatal consequences such as embolic component-related stroke or another organ infarction.

摘要

一名有风湿性瓣膜病病史的46岁男性,分别接受了使用On-X和CarboMedics Top Hat瓣环上机械瓣膜的二尖瓣和主动脉瓣置换术。瓣膜置换手术后七个月,患者出现头晕。作为对头晕进行全面检查的一部分,进行了脑部CT扫描。CT扫描显示右侧大脑中动脉M2分支有一个小的金属密度影。该金属密度影被认为是一个金属栓子,它起源于机械瓣膜或缝合材料,即Cor-Knot紧固件。尽管在我们这个病例中,头晕被认为是良性阵发性位置性眩晕的结果,但通过这个病例,我们旨在强调机械瓣膜这种极其罕见的结构并发症。这种并发症可能会产生严重且潜在致命的后果,如与栓塞成分相关的中风或其他器官梗死。

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