Inoue A, Hara Y, Kuroda H, Ishiguro S, Ashida Y, Mori T
Second Department of Surgery, Tottori University, Faculty of Medicine, Yonago, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1996 Jun;44(6):835-8.
A 76-year-old female was admitted to our hospital due to anterior chest pain and dyspnea. Mitral regurgitation due to prolapse of the posterior leaflet was detected by UCG. After admission, massive gastric hemorrhage was observed. Because hemostatic therapy using endoscopy was not effective, partial gastrectomy was performed. The origin of the hemorrhage, an acute gastric ulcer, was located on the side of the minor curvature of the corpus ventriculi. After gastrectomy, the patient underwent medical treatment using an IABP, but the left heart failure was not reduced, and the pulmonary edema worsened. At 18 hours after gastrectomy, MVR was performed. The cause of regurgitation is torn chordae of the posterior leaflet. The postoperative course was good, and the patient is doing well in NYHA class 1. This case is the first report of acute mitral insufficiency associated with acute gastric lesion in Japan.
一名76岁女性因前胸疼痛和呼吸困难入院。经超声心动图检查发现后叶脱垂导致二尖瓣反流。入院后,观察到大量胃出血。由于内镜止血治疗无效,遂行胃部分切除术。出血源为急性胃溃疡,位于胃体小弯侧。胃切除术后,患者使用主动脉内球囊反搏进行治疗,但左心衰竭未减轻,肺水肿加重。胃切除术后18小时,进行了二尖瓣置换术。反流原因是后叶腱索撕裂。术后病程良好,患者目前纽约心脏协会心功能分级为Ⅰ级,状况良好。该病例是日本首例与急性胃部病变相关的急性二尖瓣关闭不全的报道。