Agathos E A, Moran M, Mangion J, Lovell A, Engelman R M, Rousou J A
Departments of Cardiac Surgery, Baystate Medical Center, Massachusetts, USA.
J Heart Valve Dis. 1996 May;5(3):309-11.
A 77-year-old male patient presented with symptoms of shortness of breath, fatigue, chest pain on exertion and dizziness. Transthoracic echocardiography suggested the presence of a diaphragmatic type of obstruction in the subaortic area of the left ventricular outflow tract. The systolic peak gradient at rest was 34 mmHg with a mean of 23 mmHg. Cardiac catheterization demonstrated rounded radiolucencies in the left ventricular outflow tract in the form of two "pouches" that moved back and forth causing subaortic stenosis. There was also a 70% stenosis of the left anterior descending coronary artery. Left ventricular function was normal. At surgery, a transesophageal echocardiogram demonstrated two distinct pouches arising from the anterior leaflet of the mitral valve. The larger of the two originated near the free edge of the leaflet and was attached via a chord to the membranous septum traversing the subaortic area of the left ventricular outflow tract. The patient underwent a left internal mammary to left anterior descending bypass graft, excision of the larger pouch and over-sewing of the smaller pouch. The excision and repair were performed through the aortic root and aortic valve. The patient made an uncomplicated recovery and on follow up his symptoms disappeared. This case shows the excellent results that can be obtained by surgery of diverticula of the mitral valve causing intermittent subaortic stenosis, a rare pathologic entity, morphologically different from the classical diaphragmatic subaortic stenosis.
一名77岁男性患者出现呼吸急促、乏力、劳力性胸痛和头晕症状。经胸超声心动图提示左心室流出道主动脉下区域存在膈膜型梗阻。静息时收缩期峰值梯度为34 mmHg，平均为23 mmHg。心导管检查显示左心室流出道有圆形透亮区，呈两个“囊袋”状，来回移动导致主动脉下狭窄。左前降支冠状动脉也有70%的狭窄。左心室功能正常。手术时，经食管超声心动图显示二尖瓣前叶有两个明显的囊袋。两者中较大的一个起源于瓣叶游离缘附近，并通过一根腱索附着于穿过左心室流出道主动脉下区域的膜性间隔。患者接受了左乳内动脉至左前降支搭桥术，切除较大的囊袋并缝合较小的囊袋。切除和修复通过主动脉根部和主动脉瓣进行。患者恢复顺利，随访时症状消失。该病例显示，对于由二尖瓣憩室引起的间歇性主动脉下狭窄（一种罕见的病理实体，形态上不同于经典的膈膜型主动脉下狭窄）进行手术可取得良好效果。
