Khan Kashmala, Taweesedt Pahnwat T, Venkatachalam Sridhar, Surani Salim
Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA.
Cardiology, Corpus Christi Medical Center, Corpus Christi, USA.
Cureus. 2020 Dec 4;12(12):e11897. doi: 10.7759/cureus.11897.
Paravalvular leaks (PVL) are an uncommon sequelae of valve replacement but can be seen as a complication of both mechanic and prosthetic valves. Patients with PVL may remain asymptomatic or have detrimental complications, which include heart failure, hemodynamically significant hemolysis, and endocarditis. Management depends on the clinical presentation and the degree of the valvular leak. We hereby present a case report of a patient with a complicated clinical course secondary to a PVL of the mitral valve. The patient had a recent mitral valve replacement and presented with symptoms of heart failure that was refractory to standard medical therapy. Valvular abnormality was not seen with initial trans-thoracic echocardiogram (TTE), but with high clinical suspicion, a trans-esophageal echocardiogram (TEE) was done confirming a PVL. The patient's condition continued to deteriorate; he became hemodynamically unstable with end-organ damage. Cardiothoracic surgery was consulted for surgical repair of the PVL. The patient, however, remained too unstable for surgery and the family opted for comfort measures per the patient's wishes.
瓣周漏（PVL）是瓣膜置换术后不常见的后遗症，但可视为机械瓣膜和人工瓣膜的并发症。瓣周漏患者可能无症状或出现有害并发症，包括心力衰竭、具有血流动力学意义的溶血和心内膜炎。治疗取决于临床表现和瓣膜漏的程度。我们在此报告一例二尖瓣瓣周漏继发复杂临床过程的病例。该患者近期进行了二尖瓣置换术，出现了标准药物治疗无效的心力衰竭症状。最初的经胸超声心动图（TTE）未发现瓣膜异常，但由于临床高度怀疑，进行了经食管超声心动图（TEE）检查，证实存在瓣周漏。患者病情持续恶化；他出现血流动力学不稳定并伴有终末器官损害。咨询心胸外科进行瓣周漏的手术修复。然而，患者仍因过于不稳定而无法进行手术，家属根据患者意愿选择了姑息治疗措施。
