| 摘要: |
| 患者因“反复心累、气促1+年，加重3+月”入院。术前TTE诊断为：主动脉瓣重度返流，二尖瓣轻度返流，感染性心内膜炎可能性。患者拟行主动脉瓣置换术。麻醉后TEE再次明确术前超声诊断，外科医师遂即体外循环下行主动脉瓣置换术。体外循环脱机后TEE监测发现二尖瓣前叶瓣体出现新增反流束，缩流颈为2mm，考虑以下原因：1. 术前超声及术中TEE漏诊的可能性；2.可疑医源性二尖瓣损伤；3.因术中未对二尖瓣进行探查，不排除血流动力学不稳定加重瓣体损伤。外科医师遂即行二尖瓣瓣叶修复术，术后TEE显示二尖瓣前叶瓣体反流消失，主动脉瓣未见瓣周漏。患者于术后12天顺利出院。 |
| 关键词: 主动脉瓣置换，二尖瓣穿孔，经食道超声心动图 |
| DOI： |
| 投稿时间：2022-04-25修订日期：2022-05-10 |
| 基金项目: |
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| Mitral valve perforation after aortic valve replacement：A case report |
| tangyuling,yangxuedan,lixuejie |
| (West China Hospital of Sichuan University) |
| Abstract: |
| The patient was admitted to the hospital with repeated heart fatigue, shortness of breath for 1+ years, and aggravation for 3+ months. Severe aortic regurgitation, mild mitral regurgitation, and infective endocarditis were diagnosed by preoperative TTE. The patient was scheduled for aortic valve replacement. After anesthesia, TEE confirmed the preoperative ultrasound diagnosis again, and the surgeon performed aortic valve replacement under cardiopulmonary bypass. After cardiopulmonary bypass weaning, TEE found a new regurgitation bundle in the anterior mitral valve leaflet, and the vena contracta was 2 mm. The following reasons were considered:1. The possibility of missed diagnosis by preoperative ultrasonography and intraoperative TEE; 2. Suspected iatrogenic mitral valve injury; 3. The mitral valve was not detected during the operation, and it could not be ruled out that hemodynamic instability aggravates valve damage. The surgeon then performed the mitral valve leaflet repair. Postoperative TEE showed no anterior leaflet regurgitation in the mitral valve,and no paravalvular leakage of the aortic valve. The patient was discharged 12 days after the operation. |
| Key words: Aortic valve replacement,Mitral valve perforation,Transesophageal echocardiography |
