Goda T, Ishii K, Shiiya N, Oba J, Matsui Y, Yasuda K
Department of Cardiovascular Surgery, Hokkaido University, School of Medicine, Sapporo, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1994 Jul;42(7):1092-5.
A 64-year-old man who had received a Carpentier-Edward mitral valve replacement seven years earlier was seen with dyspnea on exertion. After re-replacement of the mitral valve with SJM prosthesis, the patient developed acute left-sided heart failure on the third postoperative day. Transesophageal echocardiography revealed abnormal lumen posterior to the left atrium with regurgitant flow from the left ventricle. Right and left atriotomy revealed dissection of the interatrial septum and after removal of the prosthesis, communication between the left ventricle and the dissected lumen was recognized. After closing the communicating orifice, SJM prosthesis was again sutured on the mitral annulus with sub-annular pledgets to reinforce the annular attachment. Excessive debridement of the annular tissue was thought to be a causative factor to develop the dissection of the interatrial septum after mitral valve replacement.
一名64岁男性，7年前接受了卡朋蒂埃-爱德华二尖瓣置换术，现因劳力性呼吸困难前来就诊。在用圣犹达医疗公司（SJM）的人工瓣膜再次置换二尖瓣后，患者在术后第三天出现急性左侧心力衰竭。经食管超声心动图显示左心房后方管腔异常，有来自左心室的反流。右心房和左心房切开术显示房间隔夹层，移除人工瓣膜后，发现左心室与夹层管腔相通。关闭相通孔后，再次用瓣环下棉垫将SJM人工瓣膜缝合在二尖瓣环上，以加强瓣环固定。二尖瓣置换术后房间隔夹层形成的一个致病因素被认为是瓣环组织过度清创。
