PDF(Pubmed)
Abstract：
UNASSIGNED: Mitral regurgitation may develop or worsen following right ventricular apical pacing due to dyssynchronous left ventricular contraction. Pre-existing secondary mitral annular dilation is a well-recognized and important contributing factor. This description of pacing-induced torrential mitral regurgitation in the setting of rheumatic mitral valve disease is a rare case in which a primary mitral valve lesion was the antecedent mechanism.
UNASSIGNED: A 60-year-old man was admitted with dizziness and pre-syncope. Twelve-lead electrocardiogram showed complete heart block. A dual-chamber pacemaker was implanted and programmed in DDD mode. Transthoracic echocardiography performed a day later demonstrated a left ventricular ejection fraction (LVEF) of 63% and moderate mitral regurgitation. The patient presented 4 months later with breathlessness and orthopnoea. Pacemaker interrogation demonstrated a 98% right ventricular pacing burden. Echocardiography revealed torrential mitral regurgitation secondary to left ventricular dyssynchrony and complete loss of leaflet coaptation with preserved systolic function. Post-capillary pulmonary hypertension was diagnosed following right heart catheterization. The patient underwent metallic mitral valve replacement, tricuspid annuloplasty, and left internal mammary artery grafting to the left anterior descending artery for a severe proximal stenosis. On inspection, the native mitral valve was notably rheumatic in appearance, and this was confirmed histologically.
UNASSIGNED: It is important to closely monitor the progression of mitral regurgitation in those with primary mitral valve disease undergoing right ventricular pacing. Early follow-up may prevent the adverse haemodynamic consequences of worsening mitral regurgitation, with a greater chance of recovery of left ventricular function following surgery.
UNASSIGNED: A 60-year-old man was admitted with dizziness and pre-syncope. Twelve-lead electrocardiogram showed complete heart block. A dual-chamber pacemaker was implanted and programmed in DDD mode. Transthoracic echocardiography performed a day later demonstrated a left ventricular ejection fraction (LVEF) of 63% and moderate mitral regurgitation. The patient presented 4 months later with breathlessness and orthopnoea. Pacemaker interrogation demonstrated a 98% right ventricular pacing burden. Echocardiography revealed torrential mitral regurgitation secondary to left ventricular dyssynchrony and complete loss of leaflet coaptation with preserved systolic function. Post-capillary pulmonary hypertension was diagnosed following right heart catheterization. The patient underwent metallic mitral valve replacement, tricuspid annuloplasty, and left internal mammary artery grafting to the left anterior descending artery for a severe proximal stenosis. On inspection, the native mitral valve was notably rheumatic in appearance, and this was confirmed histologically.
UNASSIGNED: It is important to closely monitor the progression of mitral regurgitation in those with primary mitral valve disease undergoing right ventricular pacing. Early follow-up may prevent the adverse haemodynamic consequences of worsening mitral regurgitation, with a greater chance of recovery of left ventricular function following surgery.
摘要：
■右心室心尖部起搏后，由于左心室收缩不同步，二尖瓣返流可能会发展或恶化。预先存在的次级二尖瓣环扩张是公认且重要的促成因素。风湿性二尖瓣疾病中起搏引起的二尖瓣反流的描述很少见，其中原发性二尖瓣病变是先发机制。
■一名60岁男子因头晕和晕厥前入院。十二导联心电图显示完全心脏传导阻滞。植入双腔起搏器并以DDD模式进行编程。一天后进行的经胸超声心动图显示左心室射血分数（LVEF）为63％和中度二尖瓣反流。4个月后，患者出现呼吸困难和端视呼吸。起搏器询问显示98％的右心室起搏负担。超声心动图显示二尖瓣反流继发于左心室不同步，小叶接合完全丧失，收缩功能保留。右心导管插入后诊断为毛细血管后肺动脉高压。病人接受了金属二尖瓣置换术,三尖瓣成形术,左乳内动脉移植到左前降支治疗严重的近端狭窄。检查时，天然二尖瓣在外观上明显是风湿性的，这在组织学上得到了证实。
■在接受右心室起搏的原发性二尖瓣疾病患者中，密切监测二尖瓣反流的进展非常重要。早期随访可以预防二尖瓣反流恶化的不良血流动力学后果，手术后左心室功能恢复的机会更大。
■一名60岁男子因头晕和晕厥前入院。十二导联心电图显示完全心脏传导阻滞。植入双腔起搏器并以DDD模式进行编程。一天后进行的经胸超声心动图显示左心室射血分数（LVEF）为63％和中度二尖瓣反流。4个月后，患者出现呼吸困难和端视呼吸。起搏器询问显示98％的右心室起搏负担。超声心动图显示二尖瓣反流继发于左心室不同步，小叶接合完全丧失，收缩功能保留。右心导管插入后诊断为毛细血管后肺动脉高压。病人接受了金属二尖瓣置换术,三尖瓣成形术,左乳内动脉移植到左前降支治疗严重的近端狭窄。检查时，天然二尖瓣在外观上明显是风湿性的，这在组织学上得到了证实。
■在接受右心室起搏的原发性二尖瓣疾病患者中，密切监测二尖瓣反流的进展非常重要。早期随访可以预防二尖瓣反流恶化的不良血流动力学后果，手术后左心室功能恢复的机会更大。
