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一位患有高安动脉炎的患者在再次进行主动脉瓣置换手术后,主动脉夹层延伸至室间隔:一例罕见病例报告。

Aortic dissection extending into the interventricular septum following redo aortic valve replacement surgery in a patient with Takayasu's arteritis: a rare case report.

作者信息

Hu Chan-Han, Chang Chun-Hao, Tsai Meng-Ta, Tsai Wei-Chuan, Huang Mu-Shiang

机构信息

Division of Cardiology, Department of Internal Medicine, College of Medicine, National Cheng Kung University, No. 138, Shengli Rd., North Dist., Tainan City 704302, Taiwan (R.O.C.).

Division of Cardiovascular Surgery, Department of Surgery, College of Medicine, National Cheng Kung University, No. 138, Shengli Rd., North Dist., Tainan City 704302, Taiwan (R.O.C.).

出版信息

Eur Heart J Case Rep. 2024 Sep 10;8(9):ytae496. doi: 10.1093/ehjcr/ytae496. eCollection 2024 Sep.

Abstract

BACKGROUND

Takayasu's arteritis is an infrequent manifestation of vasculitis affecting the aorta and its primary branches with numerous symptoms. This report details a rare case wherein a patient developed interventricular septal dissection following aortic valve replacement.

CASE SUMMARY

A middle-aged woman diagnosed with Takayasu's arteritis previously underwent aortic valve replacement with a mechanical valve owing to severe aortic regurgitation. Subsequently, she received a redo aortic valve replacement following an episode of prosthetic valve infective endocarditis with paravalvular leak. Heart failure symptoms emerged during follow-up, revealing aortic root dissection extending into the interventricular septum, causing significant prosthetic valve movement. A Trido Bentall operation and interventricular septum repair were performed, and the patient recovered smoothly.

DISCUSSION

Interventricular dissection, although uncommon, may be due to factors such as infection, myocardial infarction, congenital anomalies, trauma, or post-surgical shear stress. Timely diagnosis is imperative to prevent life-threatening complications; surgery remains the primary treatment. The present case report describes a rare presentation that was successfully managed through a Bentall operation and underscores the necessity of prompt intervention in treating this condition.

摘要

背景

高安动脉炎是一种罕见的血管炎表现,累及主动脉及其主要分支,症状多样。本报告详细介绍了一例罕见病例,该患者在主动脉瓣置换术后发生室间隔夹层。

病例摘要

一名先前被诊断为高安动脉炎的中年女性因严重主动脉瓣反流接受了机械瓣主动脉瓣置换术。随后,在发生人工瓣膜感染性心内膜炎伴瓣周漏后,她接受了再次主动脉瓣置换术。随访期间出现心力衰竭症状,显示主动脉根部夹层延伸至室间隔,导致人工瓣膜明显移位。进行了三联 Bentall 手术和室间隔修复,患者顺利康复。

讨论

室间隔夹层虽然不常见,但可能由感染、心肌梗死、先天性异常、创伤或手术后剪切应力等因素引起。及时诊断对于预防危及生命的并发症至关重要;手术仍然是主要治疗方法。本病例报告描述了一种通过 Bentall 手术成功治疗的罕见表现,并强调了及时干预治疗这种疾病的必要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3489/11413577/e9f0cad12731/ytae496il2.jpg

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