Livesay James E, Litton Kayleigh M, Bresee Stuart J
Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, United States.
Heart Lung Vascular Institute, University of Tennessee Medical Center, Knoxville, TN, United States.
J Cardiol Cases. 2021 Jun 4;24(5):247-249. doi: 10.1016/j.jccase.2021.04.015. eCollection 2021 Nov.
A variety of conditions can lead to left ventricle outflow tract obstruction, but cases of subaortic stenosis decades following a mitral valve replacement are exceedingly rare. Any abnormal positioning of a prosthetic valve can result in continuous turbulence leading to permanent deposition of fibrous tissue. We present a case of a 56-year-old female that underwent mechanical mitral valve replacement, due to severe rheumatic mitral valve disease, with recurrent admissions for dyspnea. Ultimately, she underwent a left heart catheterization and during pullback from the left ventricle to the aorta a 100-mmHg pressure gradient was noted below the level of the aortic valve suggestive of subaortic stenosis. The subaortic stenosis was found to be secondary to pannus formation from her mitral valve prosthesis placed over twenty years ago. < Subaortic stenosis secondary to pannus formation decades following a mechanical mitral valve replacement is exceptionally rare. The diagnosis of subaortic stenosis can be extremely difficult requiring high clinical suspicion, transthoracic and transesophageal echocardiography, computed tomography, and/or pullback pressure during left heart catheterization.>.
多种情况可导致左心室流出道梗阻，但二尖瓣置换术后数十年发生主动脉瓣下狭窄的病例极为罕见。人工瓣膜的任何异常定位都可能导致持续的湍流，进而导致纤维组织的永久性沉积。我们报告一例56岁女性患者，因严重风湿性二尖瓣疾病接受了机械二尖瓣置换术，因呼吸困难反复入院。最终，她接受了左心导管检查，在从左心室回撤至主动脉的过程中，在主动脉瓣水平以下发现了100mmHg的压力阶差，提示主动脉瓣下狭窄。发现主动脉瓣下狭窄继发于二十多年前植入的二尖瓣人工瓣膜形成的血管翳。<机械二尖瓣置换术后数十年因血管翳形成继发主动脉瓣下狭窄极为罕见。主动脉瓣下狭窄的诊断可能极其困难，需要高度的临床怀疑、经胸和经食管超声心动图、计算机断层扫描和/或左心导管检查期间的回撤压力。>
