Sudo Y, Takahara Y
Division of Cardiovascular Surgery, Funabashi Municipal Medical Center, Chiba, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1995 Jul;43(7):1050-4.
A 60-year-old man who undergone uneventful mitral valve replacement 9 years and 5 months previously was referred to us because his chest roentgenogram showed rapidly growing abnormal shadow. Two-dimensional echo cardiography revealed a left ventricular pseudoaneurysm. Emergent surgery was performed under the cardiopulmonary bypass. The aneurysm, which arose posteriorly from the base of the left ventricle, had a thin wall that could be separated from the pericardium. It was therefore diagnosed to be a subepicardial aneurysm. Examination of his previously implanted mitral prosthesis (a Duromedicus valve) revealed that the mitral orifice was partially occluded by a thrombus. The Duromecicus valve was therefore removed, and the ruptured left ventricular wall was closed from both outside and inside. A St. Jude Medical valve was then placed in the mitral position. Pseudoaneurysm or subepicardial aneurysm formation is a possible late complication after mitral valve replacement. Physicians and surgeons should be aware of this late complication in patients who had undergone mitral valve replacement because it urgently requires surgical correction.
一名60岁男性，9年零5个月前接受二尖瓣置换术，术后恢复顺利。此次因胸部X光片显示异常阴影迅速增大而转诊至我院。二维超声心动图显示左心室假性动脉瘤。在体外循环下进行了急诊手术。动脉瘤起源于左心室底部后侧，壁薄，可与心包分离。因此诊断为心外膜下动脉瘤。检查其先前植入的二尖瓣假体（Duromedicus瓣膜）发现二尖瓣口部分被血栓阻塞。因此移除了Duromecicus瓣膜，从内外两侧封闭破裂的左心室壁。然后在二尖瓣位置植入了圣犹达医疗瓣膜。假性动脉瘤或心外膜下动脉瘤形成是二尖瓣置换术后可能出现的晚期并发症。内科医生和外科医生应意识到二尖瓣置换术后患者的这种晚期并发症，因为它急需手术矫正。
