Department of Cardiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India.
F1000Res. 2024 Oct 1;13:306. doi: 10.12688/f1000research.145007.2. eCollection 2024.
Postoperative complications are an integral part of valve surgery. Common complications include hematomas, bleeding, valve dehiscence, paravalvular leak, and acute PV thrombosis. With the available data from published articles, the rate of all valve-related complications is 0.7 to 3.5% per patient annually. [1] The pathology involved is multifactorial, often blood vessel injury leading to bleeding and hematoma. Although postoperative complications are evident, incidental diagnosis of a cardiac mass in an asymptomatic and hemodynamically stable patient postoperatively is crucial, requiring non-invasive imaging for immediate surgical action.
A woman in her 50s presented with chief complaints of worsening dyspnoea with suddenonset and chest pain. Clinical findings showed apex shifted downward and outward, wide split S2, and a mid systolic murmur radiating to the mid axillary line. Twelve-lead ECG showed LA enlargement, that aligned with X-ray findings. 2D Echocardiography revealed MVP with severe MR and a dilated LV. The patient underwent successful mitral valve replacement as per ACC/AHA class I recommendation. However, postoperative TTE showed a remarkably large mass measuring 5.6 cm*4.6 cm in the RA. Reexploration was performed, followed by mass excision. Plenty of organized clots were seen compressing the RA. TEE showed no evidence of mass. Following stabilization,the patient was discharged considering optimal INR values and prosthetic valve function assessed by echocardiography. The patient's symptoms improved during the first follow-up.
Although postoperative cardiac complications are common, appropriate diagnosis with TTE and TEE has benefited surgeons. TEE-guided reexploration aids surgeons in decision-making and strategic approaches. Failure to diagnose such complications in asymptomatic patients can ultimately complicate the procedure. Henceforth, sonographers must be skilled in the detection and identification of unusual complications to guide redo interventions. Such an approach minimizes mortality, redo procedures, and avoids CPB hence reducing long-term prognosis and outcomes with valve replacement.
术后并发症是瓣膜手术不可分割的一部分。常见并发症包括血肿、出血、瓣环撕裂、瓣周漏和急性 PV 血栓形成。根据已发表文章中的可用数据，每年每位患者的所有与瓣膜相关并发症的发生率为 0.7%至 3.5%。[1]所涉及的病理是多因素的，通常是血管损伤导致出血和血肿。尽管术后并发症明显，但在术后无症状和血流动力学稳定的患者中偶然诊断出心脏肿块至关重要，需要进行无创成像以立即进行手术。
一名 50 多岁的女性患者主诉呼吸困难逐渐加重，伴有突发胸痛。临床发现心尖向下向外移位，第二心音分裂增宽，收缩中期杂音放射至中腋线。12 导联心电图显示左心房扩大，与 X 线结果一致。二维超声心动图显示 MVP 伴严重 MR 和 LV 扩张。患者根据 ACC/AHA Ⅰ类建议成功接受了二尖瓣置换术。然而，术后 TTE 显示右心房（RA）内有一个明显的大肿块，大小为 5.6cm*4.6cm。进行了再次探查，随后进行了肿块切除术。大量的已形成的血栓被看到压迫 RA。TEE 显示无肿块证据。在稳定后，考虑到 INR 值和超声心动图评估的人工瓣膜功能最佳，患者出院。患者的症状在第一次随访时得到改善。
尽管术后心脏并发症很常见，但 TTE 和 TEE 的适当诊断对外科医生有益。TEE 引导的再次探查有助于外科医生做出决策和采取策略。无症状患者未诊断出此类并发症最终会使手术复杂化。因此，超声科医生必须具备检测和识别异常并发症的技能，以指导再次干预。这种方法最大限度地降低了死亡率、再次手术和避免 CPB，从而改善了瓣膜置换术的长期预后和结果。
