背景:必须根据具体情况确定与二尖瓣手术相关的二尖瓣环钙化的适当管理。然而,既定的程序仍然不确定。
方法:本报告描述了一例71岁女性因严重二尖瓣和主动脉瓣狭窄与严重二尖瓣环钙化相关的手术病例,该女性接受了颈圈增强二尖瓣假体二尖瓣置换术。患者在心力衰竭治疗后接受了手术修复。由于目前的患者被认为是常规二尖瓣置换术的高风险,我们用牛心包补片在假体的心室侧周向扩大的复合人工瓣膜。首先,固体钙棒保持不变,仅去除容易散落的易碎钙化块。随后,假体通过两条床垫缝线固定,缝线放置在扩张的钙化心肌区域的心房内位置.此外,十条床垫缝线放置在能够将缝线从心室侧传递到心房侧的其他区域的环形上位置。最后,使用4-0聚丙烯加固,将1.5厘米宽的修剪过的牛心包项圈从环到心房壁周向缝合。尽管对急性肾功能衰竭进行了临时血液透析,患者仍无症状。
结论:本病例提示使用颈圈增强二尖瓣假体的二尖瓣置换术可能是治疗严重二尖瓣环钙化的有效技术。为了避免与严重钙化环治疗相关的灾难性并发症,在无法进行常规二尖瓣置换术的情况下,对手术策略进行审慎的术前决策至关重要。
BACKGROUND: Appropriate management of mitral annular calcification associated with mitral valve surgery must be determined on a
case-by-
case basis. However, an established procedure remains uncertain.
METHODS: This report describes a surgical
case of severe mitral and aortic valve stenosis associated with severe mitral annular calcification in a 71-year-old woman who underwent mitral valve replacement with a collar-reinforced mitral prosthesis. The patient underwent surgical repair after the treatment for heart failure. As the present patient was deemed to be at high risk for conventional mitral valve replacement, we applied a composite prosthetic valve that was enlarged circumferentially on the ventricular side of the prosthesis with a bovine pericardial patch. First, the solid calcium bar was left untouched and only the friable calcified mass that was easily scattered was removed. Subsequently, the prosthesis was secured by two mattress sutures placed in the intra-atrial position at the region of the extended calcified myocardium. Additionally, ten mattress sutures were placed in the supra-annular position at the other regions capable of passing stitches from the ventricular side to the atrial side. Finally, a 1.5 cm wide trimmed bovine pericardial collar was sutured circumferentially from the annulus to the atrial wall using running 4-0 polypropylene for reinforcement. Although temporary hemodialysis was performed for acute renal failure, the patient remained asymptomatic.
CONCLUSIONS: The present
case suggests that mitral valve replacement using a collar-reinforced mitral prosthesis may be an effective technique for severe mitral annular calcification. To avoid catastrophic complications associated with treatment for severely calcified annulus, it is crucial to make a prudent preoperative decision regarding the surgical strategy under circumstances where conventional mitral valve replacement is impossible.