Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University Hospital, Wakayama City, Japan.
Interact Cardiovasc Thorac Surg. 2022 Sep 9;35(4). doi: 10.1093/icvts/ivac232.
Tumours or tumour-like lesions around the aortic valve are relatively rare and are difficult to diagnose. We report an interesting case of calcified thrombi in the Valsalva sinuses and coronary cusps that mimicked an aortic valve tumour. A 68-year-old man presented with a 20-mm calcified mass in the non-coronary and left-coronary cusps extending to their corresponding Valsalva sinuses, which was detected by echocardiography and contrast-enhanced computed tomography. The lesions were resected to establish the diagnosis and prevent systemic embolization. Intraoperative and histopathological examination revealed an atrophied non-coronary leaflet and calcified atherosclerotic lesions of the Valsalva sinuses and contiguous parts of the cusps, with ulceration and fibrin thrombi. The lesions were resected and aortic valve replacement was performed to avoid aortic valve dysfunction. The patient's atrial fibrillation was controlled, and anticoagulants were discontinued 3 months postoperatively. Surgery to establish the diagnosis and to prevent systemic thromboembolism was thought to be reasonable, even in the absence of valvular dysfunction.
主动脉瓣周围的肿瘤或肿瘤样病变相对少见，且难以诊断。我们报告了一例有趣的病例，瓦尔萨尔瓦窦和冠状动脉瓣的钙化血栓模拟了主动脉瓣肿瘤。一名 68 岁男性因超声心动图和增强计算机断层扫描检测到非冠状动脉瓣和左冠状动脉瓣有 20 毫米的钙化肿块延伸至相应的瓦尔萨尔瓦窦而就诊。切除病变以明确诊断并预防全身性栓塞。术中及组织病理学检查显示非冠状动脉瓣叶萎缩，瓦尔萨尔瓦窦及相邻瓣叶有钙化粥样硬化病变，伴有溃疡和纤维蛋白血栓。切除病变并进行主动脉瓣置换以避免主动脉瓣功能障碍。患者的心房颤动得到控制，术后 3 个月停用抗凝剂。即使没有瓣膜功能障碍，手术以明确诊断和预防全身性血栓栓塞也是合理的。
