[Case report of bioprosthetic mitral valve malfunction associated with right pulmonary embolism and heart failure].
The perioperative treatment of open heart surgery cases with preoperative pulmonary embolism is controversial. A 40-year-old woman, who had undergone mitral valve replacement with a bioprosthetic valve 16 years earlier, showed severe heart failure, right pulmonary embolism diagnosed by pulmonary perfusion scan in the subacute stage, and prosthetic valve regurgitation. Preoperative catheterization showed severe pulmonary hypertension of 122 mmHg, equal to the systemic pressure. Pulmonary angiography showed right peripheral pulmonary embolism without main pulmonary artery embolism. Prosthetic valve replacement with a BICARBON 27 M and tricuspid annuloplasty were performed, with thrombolytic therapy before and after operation without thrombectomy, because of pulmonary hypertension attributed to prosthetic valve regurgitation. Pulmonary perfusion scan and angiography showed improvement of pulmonary embolism after treatment. Postoperative catheterization showed good results, with right and left pulmonary artery pressure of 43/16(23) and 39/15(24) mmHg, mean pulmonary capillary wedge pressure of 4 mmHg, and cardiac index of 4.96 l/min/m2. It is important to make an early diagnosis of pulmonary embolism and treat the major cause of pulmonary hypertension in cases of cardiac valve disease with pulmonary hypertension.
Jung
E
E
Department of Cardiovascular Surgery, Kyoto Second Red Cross Hospital, Kyoto, Japan.
Kou
E
E
Yokoyama
S
S
Naito
Y
Y
D000328:Adult; D001705:Bioprosthesis; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D011475:Prosthesis Failure; D011655:Pulmonary Embolism / Q000150:complications*; D012086:Reoperation