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栓塞的机械主动脉瓣小叶导致肾下腹主动脉狭窄和间歇性跛行。

Embolized mechanical aortic valve leaflet causing infrarenal aortic stenosis and claudication.

作者信息

Eldreth Bryan, Hadjizacharia Pantelis, Feuer David

机构信息

Rocky Vista University College of Osteopathic Medicine, Parker, Colo.

Parkview Vascular Center, Pueblo, Colo.

出版信息

J Vasc Surg Cases Innov Tech. 2020 Sep 2;6(4):534-538. doi: 10.1016/j.jvscit.2020.08.009. eCollection 2020 Dec.

DOI:10.1016/j.jvscit.2020.08.009
PMID:33134636
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7588809/
Abstract

Leaflet escape from mechanical heart valves is a rare but potentially fatal complication of prosthetic valve replacement. Historically, the incompetent valve is replaced emergently and the escaped leaflet is subsequently retrieved from its settlement in a distal vessel. If it is not retrieved, the fragment can increase the risk of infection, thrombosis, and migration. We report a case of a mechanical aortic valve leaflet that embolized during valve reoperation and caused occlusive aortic disease found 2 years later. This case emphasizes the importance of locating leaflet fragments after they are noticed missing.

摘要

机械心脏瓣膜瓣叶脱出是人工瓣膜置换术后一种罕见但可能致命的并发症。从历史上看，功能不全的瓣膜会紧急更换，随后从其在远端血管中的停留处取出脱出的瓣叶。如果不取出，碎片会增加感染、血栓形成和迁移的风险。我们报告了一例机械主动脉瓣瓣叶在瓣膜再次手术期间再次手术期间发生栓塞，并在2年后导致闭塞性主动脉疾病的病例。该病例强调了在发现瓣叶碎片缺失后定位其位置的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d2b/7588809/a02a1f06d864/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d2b/7588809/ea41b9dc2924/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d2b/7588809/a02a1f06d864/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d2b/7588809/ea41b9dc2924/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d2b/7588809/a02a1f06d864/gr2.jpg

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本文引用的文献

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Spontaneous leaflet fracture resulting in embolization from mechanical valve prostheses.机械瓣膜假体导致的自发性瓣叶破裂并引起栓塞。
J Card Surg. 2019 Mar;34(3):124-130. doi: 10.1111/jocs.13975. Epub 2018 Dec 30.
2
Leaflet escape in an Edwards TEKNA mitral prosthesis.爱德华兹TEKNA二尖瓣假体瓣叶脱出
Gen Thorac Cardiovasc Surg. 2018 Dec;66(12):744-747. doi: 10.1007/s11748-018-0891-4. Epub 2018 Mar 13.
3
Acute Mitral Valve Dysfunction Due to Escape of Prosthetic Mechanical Leaflet and Peripheral Leaftlet Embolization.
人工机械瓣叶脱出及外周瓣叶栓塞导致的急性二尖瓣功能障碍
Heart Surg Forum. 2015 Dec 14;18(6):E245-9. doi: 10.1532/hsf.1316.
4
Clinical outcomes of 5358 patients undergoing direct open bypass or endovascular treatment for aortoiliac occlusive disease: a systematic review and meta-analysis.5358 例主髂动脉闭塞性疾病行直接开放旁路或血管内治疗的患者的临床转归：系统评价和荟萃分析。
J Endovasc Ther. 2013 Aug;20(4):443-55. doi: 10.1583/13-4242.1.
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Prosthetic mitral valve leaflet escape.人工二尖瓣瓣叶脱垂
J Cardiovasc Ultrasound. 2013 Jun;21(2):96-9. doi: 10.4250/jcu.2013.21.2.96. Epub 2013 Jun 26.
6
Emergency valve re-replacement for embolization of prosthetic mitral valve disc during catheterization procedure.在导管介入过程中，为了栓塞人工二尖瓣瓣叶，对紧急瓣进行重新更换。
Ann Thorac Surg. 2013 May;95(5):1784-7. doi: 10.1016/j.athoracsur.2012.09.087.
7
Long-term event-free survival with an embolised prosthetic valve leaflet in the thoracic aorta.胸主动脉内带栓塞人工瓣膜小叶的长期无事件生存。
J Cardiothorac Surg. 2008 May 30;3:34. doi: 10.1186/1749-8090-3-34.
8
Retrieval of a leaflet escaped in a Tri-technologies bileaflet mechanical prosthetic valve.取出在三技术双叶机械人工心脏瓣膜中逸出的瓣叶。
Eur J Echocardiogr. 2008 Jan;9(1):65-8. doi: 10.1016/j.euje.2006.08.018.
9
Fatal leaflet escape in an Edwards TEKNA aortic prosthesis.爱德华兹TEKNA主动脉瓣膜假体出现致命性瓣叶移位。
J Heart Valve Dis. 2006 Jan;15(1):97-9.
10
A case of missing mitral valve leaflet: radiological detection.一例二尖瓣瓣叶缺失病例：影像学检测
Eur Radiol. 2003 Dec;13 Suppl 4:L11-3.