Miller D C, Schapira J N, Stinson E B, Shumway N E
J Thorac Cardiovasc Surg. 1978 Jul;76(1):43-5.
After mitral valve replacement, symptomatic deterioration and new murmurs characterstistic of atrioventricular valvular regurgitation are usually the result of periprosthetic leaks or prosthetic dysfunction with or without endocarditis. In the case which we are reporting, an iatrogenic fistula between the left ventricle and coronary sinus was responsible for the murmur and symptoms. This type of shunt has not been previously reported. Thorough debridement of the anulus is necessary during mitral valve replacement; additionally, previously implanted prostheses are occasionally embedded in the endocardial wall and must be excised. Hematoma in the atrioventricular groove and perforations of the posterior left ventricular wall are widely recognized complications of mitral valve replacement. Similar mechanisms of injury can cause other problems such as left ventricular-right atrial communications and the unique anatomic shunt described in this report.
二尖瓣置换术后，出现症状恶化以及具有房室瓣反流特征的新杂音，通常是人工瓣膜周漏或人工瓣膜功能障碍的结果，可能伴有或不伴有心内膜炎。在我们报道的病例中，左心室与冠状窦之间的医源性瘘管导致了杂音和症状。这种类型的分流此前未见报道。二尖瓣置换术中，对瓣环进行彻底清创是必要的；此外，先前植入的人工瓣膜偶尔会嵌入心内膜壁，必须予以切除。房室沟血肿和左心室后壁穿孔是二尖瓣置换术广泛认可的并发症。类似的损伤机制可导致其他问题，如左心室 - 右心房交通以及本报告中描述的独特解剖分流。
