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題 名 | Discrete Subaortic Membranous Stenosis--A Case Report=分離型主動脈下膜型狹窄的病例報告 |
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作 者 | 陳懷民; 陳英富; 謝炯昭; 陳大鈞; 林慶正; 黃耀星; | 書刊名 | The Kaohsiung Journal of Medical Sciences |
卷 期 | 16:11 2000.11[民89.11] |
頁 次 | 頁587-591 |
分類號 | 415.315 |
關鍵詞 | 分離型主動脈下膜型狹窄; 先天性心臟異常; Discrete; Transmembranous; |
語 文 | 英文(English) |
中文摘要 | 單純性主動脈下狹窄是一種罕見的先天性心臟異常。它包括了由薄膜 或肌肉所造成的分離型和更嚴重的隧道型。在前者,通常是由半月形的纖維瞙附 著在心室中膈上或是將左心室出口圍繞所產生。這個膜狀組織有可能就在主動脈 瓣膜下或是延伸到心室的部分。我們的病人是一個22歲的女孩,因為偶然的心 雜音及漸進性呼吸困難的現象來求診。心臟超音波發現有左心室肥大,中等度主 動脈瓣逆流及重度的主動脈瓣狹窄。除此之外,病人的瓣膜呈現肥厚及冗長的現 象,且在其下方發現一個環狀的薄膜導致非常的高的壓力差(121mmHg)。病人在 心肺機輔助下接受了主動脈瓣膜置換術及瓣膜下環狀薄膜切除術。術後病人恢復 順利且常規在門診追蹤檢查。通常如果在左心室出口的壓力超過45mmHg,開刀 之後再發性主動脈狹窄,主動脈瓣膜逆流及再開刀的比例都會顯著增加。所以金 屬瓣膜置換術合併環狀薄膜切除,對我們這一位病人來講,應該是減少開刀後各 種併發症的最好的術式選擇。 |
英文摘要 | Isolated subaortic stenosis is a rare type of cardiac anomaly which has been characterized as having two types: the discrete type, including membranous or fibromuscular, and the tunnel type. In the discrete type, a crescent-shaped, fibrous curtain is attached to the ventricular septum or completely encircles the left ventricular outflow tract and can be located anywhere from immediately below the aortic valve to 10 mm or more into the body of ventricle. A 22-year-old female presented at our hospital with a divided PDA, a murmur that was found by incident and progressive exertional dyspnea. Echocardiography revealed left ventricular hypertrophy, moderate aortic insufficiency, and severe aortic stenosis characterized by a thickened aortic valve and membranous type subaortic stenosis with a transmembranous high pressure gradient, 121 mmHg. An operation to replace the aortic valve and excise the membranous collar was performed with cardiopulmonary bypass support. The patient did well during the postoperative follow-up period. If the preoperative LVOT pressure gradient had been higher than 45 mmHg, the incidence of recurrent stenosis, progression of aortic regurgitation and the need for reoperation would have been higher. In order to prevent this from happening, we chose to replace the defective valve with a mechanical valve and enucleate the discrete lesion. |
本系統中英文摘要資訊取自各篇刊載內容。