Sakata Tomoki, Pfeil Douglas, Suri Rakesh M
Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
Department of Anesthesiology & Perioperative Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.
Ann Thorac Surg Short Rep. 2024 May 28;2(4):783-786. doi: 10.1016/j.atssr.2024.05.002. eCollection 2024 Dec.
A 53-year-old male individual with chronic severe mitral regurgitation presented with biventricular dysfunction, pulmonary hypertension, and atrial fibrillation. Echocardiography demonstrated a posterior leaflet prolapse with malcoaptation. Mitral valve repair and Maze procedure were performed, revealing absent chordae and direct connection from the anterolateral papillary muscle to the posterior leaflet, consistent with partial mitral arcade. Post bypass, left ventricular dysfunction was addressed by intraaortic balloon pump placement and delayed sternal closure. Post chest closure echocardiography showed no residual mitral regurgitation and restored biventricular function. This case highlights a rare presentation of mitral regurgitation with unique anatomical anomaly, successfully managed with a comprehensive surgical approach.
一名53岁患有慢性重度二尖瓣反流的男性患者出现双心室功能障碍、肺动脉高压和心房颤动。超声心动图显示后叶脱垂伴对合不良。进行了二尖瓣修复和迷宫手术，发现腱索缺失，前外侧乳头肌与后叶直接相连，符合部分二尖瓣弓的表现。体外循环后，通过置入主动脉内球囊泵和延迟胸骨闭合来处理左心室功能障碍。胸骨闭合后超声心动图显示无残余二尖瓣反流，双心室功能恢复。该病例突出了二尖瓣反流伴有独特解剖异常的罕见表现，通过综合手术方法成功治疗。
