Matsuoka T, Hamano K, Hirata K, Kobayashi T, Nishida M, Ikeda N, Shirasawa B, Gohra H, Katoh T, Fujimura Y, Esato K
First Department of Surgery, Yamaguchi University School of Medicine, Japan.
Kyobu Geka. 1998 Dec;51(13):1127-30.
The patient was a 38-year-old man who had undergone mitral valve replacement with a Starr-Edwards disc valve (model 6520, 3 M, phi 30 mm, functional valve area: 2.85 cm2) at the age of 15 years for TR combined with corrected TGA. He developed dyspnea on exertion and palpitations at the age of 30 years, and paroxysmal supraventricular tachycardia appeared at the age of 35 years. Cardiac catheterization revealed that the PCWP was 30 mmHg and the TVA was 1.1 cm2, and a diagnosis of stenosis of the prosthetic valve was made. Thus, replacement of the Starr-Edwards disc valve using a BICARBON double leaflet valve (phi 27 mm, functional valve area: 2.85 cm2) was performed. The operative findings of the Starr-Edwards disc valve revealed a normal appearance and no pannus growth. Postoperative echocardiography and cardiac catheterization found that the TVA was 3.7 cm2 and the PCWP was 13 mmHg. The actual valve area of the disc valve sewn on the ventrical, which was anatomically RV construction might have been smaller than the ideal area; however, the double leaflet valve proved efficient in our patient. This case report serves to demonstrate that because of the postoperative difference in measurement between the actual valve area and the prostheticin ball or disc valve, patients undergoing mitral valve replacement must be followed up carefully.
该患者为一名38岁男性，15岁时因三尖瓣反流合并矫正型大动脉转位接受了Starr-Edwards碟瓣二尖瓣置换术（型号6520，3M，直径30mm，有效瓣口面积：2.85cm²）。他在30岁时出现劳力性呼吸困难和心悸，35岁时出现阵发性室上性心动过速。心导管检查显示肺毛细血管楔压为30mmHg，三尖瓣口面积为1.1cm²，诊断为人工瓣膜狭窄。因此，使用BICARBON双叶瓣（直径27mm，有效瓣口面积：2.85cm²）置换了Starr-Edwards碟瓣。Starr-Edwards碟瓣的手术所见显示外观正常，无赘生物生长。术后超声心动图和心导管检查发现三尖瓣口面积为3.7cm²，肺毛细血管楔压为13mmHg。缝在心室上的碟瓣实际瓣口面积（解剖结构为右心室）可能小于理想面积；然而，双叶瓣在我们的患者中被证明是有效的。本病例报告旨在表明，由于实际瓣口面积与人工球瓣或碟瓣术后测量存在差异，二尖瓣置换术后的患者必须进行仔细随访。
