Nakano H, Shimakura T, Katsumata T, Shimamura Y, Yabuki A, Matsuda N
Department of Cardiovascular Surgery, Fukuyama Cardiovascular Hospital, Hiroshima, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1993 Mar;41(3):523-7.
A successful operation on a 49-year-old female with aortitis syndrome associated with prosthetic aortic valve detachment was reported. Aortic valve replacement using SJM 25A had been performed for aortic regurgitation caused by aortitis. Though her C-reactive protein (CRP) was kept between (+/-) and (2+) with prednisolone administered, general fatigue suddenly appeared 4 years after the first operation. The blood sedimentation rate was 65 mm/30 min and CRP was (4+), and the echocardiography showed abnormal movement of the prosthetic valve with perivalvular leakage on admission. Aortography showed the valve detachment and abnormal movement due to enlargement of sinuses of Valsalva, one of which was transformed as a diverticulum and projected into Left ventricular cavity with moderate leakage. After the inflammation was well controlled, she was operated upon. Dilatation of sinuses, perforation of intima around the prosthetic valve were recognized as left ventricular-aortic discontinuity, but ascending aorta was not enlarged. So the prosthetic valve was suspended below coronary ostia with transmural mattress sutures from right atrium. Postoperative course was uneventful. The postoperative aortography revealed only trivial perivalvular leakage without abnormal movement of the valve. This was a rare case of the valve detachment in the aortitis patient.
报道了一例对一名49岁患有主动脉炎综合征并伴有人工主动脉瓣脱离的女性患者进行的成功手术。该患者因主动脉炎导致主动脉瓣反流，此前已使用SJM 25A进行了主动脉瓣置换术。尽管在服用泼尼松龙期间她的C反应蛋白（CRP）一直维持在（±）至（2+）之间，但首次手术后4年她突然出现全身乏力。入院时血沉为65mm/30分钟，CRP为（4+），超声心动图显示人工瓣膜运动异常且有瓣周漏。主动脉造影显示瓣膜脱离以及由于主动脉窦扩大导致的异常运动，其中一个主动脉窦转变为憩室并突入左心室腔，伴有中度漏血。在炎症得到良好控制后，对她进行了手术。术中发现主动脉窦扩张、人工瓣膜周围内膜穿孔，呈现左心室 - 主动脉连续性中断，但升主动脉未增粗。于是通过经右心房的全层褥式缝合将人工瓣膜悬吊于冠状动脉开口下方。术后过程顺利。术后主动脉造影仅显示轻微瓣周漏血，瓣膜无异常运动。这是一例主动脉炎患者瓣膜脱离的罕见病例。
