Curran Brett F, Schaff Hartzell V
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Ann Thorac Surg Short Rep. 2023 Jun 26;1(4):647-649. doi: 10.1016/j.atssr.2023.06.002. eCollection 2023 Dec.
A 72-year-old woman presented with dyspnea 2 years after mitral valve replacement with a 25-mm Epic bioprosthesis. Exercise echocardiography revealed a mean transvalvular gradient of 16 mm Hg, consistent with functional mitral stenosis due to prosthesis-patient mismatch. Because of the anticipated difficulties with insertion of a larger prosthesis, we proceeded with bypass of the mitral valve using a left atrial to left ventricular valved conduit. The patient had resolution of symptoms, and imaging demonstrated a widely patent graft. Left atrial to left ventricular bypass using a valved conduit is an effective treatment of mitral prosthesis-patient mismatch in the setting of severe mitral annular calcification.
一名72岁女性在接受25毫米Epic生物瓣二尖瓣置换术后2年出现呼吸困难。运动超声心动图显示平均跨瓣压差为16毫米汞柱，符合人工瓣膜-患者不匹配导致的功能性二尖瓣狭窄。由于预计植入更大人工瓣膜会有困难，我们采用左心房到左心室带瓣管道对二尖瓣进行旁路手术。患者症状缓解，影像学检查显示移植物广泛通畅。在严重二尖瓣环钙化的情况下，使用带瓣管道进行左心房到左心室旁路手术是治疗二尖瓣人工瓣膜-患者不匹配的有效方法。
