病例报告：强直性脊柱炎患者的自体心包主动脉瓣置换及二尖瓣同种异体移植术
Case report: Autopericardial aortic valve replacement and mitral homograft implantation in a patient with ankylosing spondylitis.
作者信息
Komarov R N, Tkachev M I, Ismailbaev A M, Nuzhdin M D, Savina V A, Botashev A A
机构信息
Department of Cardiovascular Surgery, I. M. Sechenov University Hospital, First Moscow State Medical University, Trubetskaya str., d 8, str.2, Moscow 119991, Russia.
Department of Cardiovascular Surgery, I. M. Sechenov University Hospital, First Moscow State Medical University, Trubetskaya str., d 8, str.2, Moscow 119991, Russia.
出版信息
Int J Surg Case Rep. 2023 Mar;104:107911. doi: 10.1016/j.ijscr.2023.107911. Epub 2023 Feb 1.
INTRODUCTION AND IMPORTANCE
Bekhterev's disease, or ankylosing spondylitis (AS), is a chronic inflammatory rheumatic disease closely related to the human leukocyte antigen (HLA)-B27. Cardiac damage in AS occurs in 2-10 % of patients more commonly as aortic insufficiency, aortitis, mitral valve fibrosis, or cardiac conduction abnormalities.
CASE PRESENTATION
In this article we present a clinical case of a 52-year-old female patient with Bekhterev's disease, who underwent aortic valve reconstruction with autopericardium and mitral homograft implantation in mitral position.
CLINICAL DISCUSSION
The use of homografts and reconstructive surgeries using autologous materials allow not only avoiding lifelong intake of anticoagulants, but also maintaining hemodynamic profile comparable to that of native valves.
CONCLUSION
This clinical case shows that treatment of patients with rheumatic diseases is a complex treatment problem that requires a personalized approach.
引言与重要性
别赫捷列夫病，即强直性脊柱炎（AS），是一种与人类白细胞抗原（HLA）-B27密切相关的慢性炎症性风湿性疾病。AS患者发生心脏损害的比例为2% - 10%，更常见的表现为主动脉瓣关闭不全、主动脉炎、二尖瓣纤维化或心脏传导异常。
病例介绍
在本文中，我们展示了一名52岁患有别赫捷列夫病的女性患者的临床病例，该患者接受了自体心包主动脉瓣重建术以及二尖瓣位同种异体二尖瓣植入术。
临床讨论
使用同种异体移植物和自体材料进行重建手术，不仅可以避免终身服用抗凝剂，还能维持与天然瓣膜相当的血流动力学状态。
结论
该临床病例表明，风湿性疾病患者的治疗是一个复杂的治疗问题，需要个性化的治疗方法。
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