Ren Shuofang, Wen Yulin, Ma Guotao, Miao Qi
Department of Cardiac Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China.
Heliyon. 2023 Jul 20;9(8):e18463. doi: 10.1016/j.heliyon.2023.e18463. eCollection 2023 Aug.
Thrombus formation on a well-conserved bicuspid aortic valve is rare. We encountered a patient with organized thrombus formation on a native bicuspid aortic valve without calcification or stenosis, which was found occasionally during an elective operation for ascending aorta replacement surgery. The location of the thrombus was just at the orifice of left coronary artery, which produced the atherosclerosis-like symptoms such like exertional chest tightness and dyspnea. And these are no apparent predisposing causes of thrombosis could be ascertained postoperatively. The patient is in excellent condition 6 months after the operation. The lesson we learned from our case is that when the patient's symptom can't correspond with his or her diagnosis, we should ask more questions, evaluate the patient thoroughly and make the differential diagnosis as possible as we can. And the surgery can be performed aggressively when patient's symptoms cannot be figured out by physical examination, not only for pathologic confirmation but also for the prevention of life-threatening complications that can caused by either condition.
在保存完好的二叶式主动脉瓣上形成血栓的情况较为罕见。我们遇到一名患者，其原生二叶式主动脉瓣上有组织化血栓形成，无钙化或狭窄，这是在择期升主动脉置换手术中偶然发现的。血栓的位置恰好在左冠状动脉口处，引发了类似动脉粥样硬化的症状，如劳力性胸闷和呼吸困难。术后未发现明显的血栓形成诱发因素。患者术后6个月状况良好。我们从该病例中得到的教训是，当患者的症状与诊断不符时，我们应进一步询问、全面评估患者并尽可能进行鉴别诊断。当通过体格检查无法明确患者症状时，应积极进行手术，这不仅是为了病理确诊，也是为了预防两种情况可能导致的危及生命的并发症。
