Asif Ashar, Benedetto Umberto, Ofoe Victor, Caputo Massimo
University of Bristol, Medical School, Senate House, Tyndall Ave, Bristol BS8 1TH, UK.
Bristol Heart Institute, University Hospitals Bristol and Weston NHS Trust, Terrell St, Bristol, BS2 8ED, UK.
Eur Heart J Case Rep. 2021 Jun 23;5(6):ytab170. doi: 10.1093/ehjcr/ytab170. eCollection 2021 Jun.
Rheumatic valve disease (RVD) is the most common cause of cardiovascular death in low-middle income nations. Surgical aortic valve (AV) interventions for RVD, especially in children, have proven problematic with graft failure, relapse, and poor compliance with anticoagulation. A novel technique involving neocuspidization of the aortic annulus using autologous pericardium to construct new AV leaflets (the Ozaki procedure) has shown promising outcomes in children with congenital AV disease; however, there are no previous recorded cases using this technique in children with RVD.
We present the case of a 15-year-old male presenting with exertional angina and dyspnoea with a background of previous rheumatic fever. Echocardiography had shown a regurgitant tricuspid AV, left ventricular dilatation with mitral valve leaflet tethering. The patient underwent the Ozaki procedure for his AV regurgitation and was discharged following an uneventful post-operative recovery. The patient had full resolution of symptoms following the procedure and remains well 3 years following his operation.
This case highlights that good outcomes with the Ozaki procedure in RVD are possible 3-years post-operatively and should prompt future studies to evaluate the procedure as a surgical option for paediatric patients in this clinical context. Additionally, the Ozaki procedure may also provide a cost-effective surgical technique requiring minimal additional operative resources and reduced follow-up demand, which would be critical in low-resource clinical settings where RVD is prevalent.
风湿性瓣膜病（RVD）是中低收入国家心血管死亡的最常见原因。针对RVD的外科主动脉瓣（AV）干预措施，尤其是在儿童中，已被证明存在移植物失败、复发以及抗凝依从性差等问题。一种使用自体心包对主动脉瓣环进行新瓣叶化以构建新的AV瓣叶的新技术（尾崎手术），在患有先天性AV疾病的儿童中已显示出有前景的结果；然而，此前尚无在患有RVD的儿童中使用该技术的记录病例。
我们报告一例15岁男性病例，该患者有劳力性心绞痛和呼吸困难症状，既往有风湿热病史。超声心动图显示三尖瓣反流、左心室扩张伴二尖瓣叶牵拉。该患者因AV反流接受了尾崎手术，术后恢复顺利，随后出院。术后患者症状完全缓解，术后3年情况良好。
该病例表明，尾崎手术在RVD患者中术后3年可能取得良好效果，这应促使未来开展研究，以评估该手术在此临床背景下作为儿科患者手术选择的可行性。此外，尾崎手术还可能提供一种具有成本效益的手术技术，所需额外手术资源最少且随访需求降低，这在RVD流行的资源匮乏临床环境中至关重要。
