先天性僧帽瓣閉鎖不全－學齡前兒童僧帽瓣人造瓣膜置換之一例報告

Congenital Mitral Insufficiency-A Case Report of Mitral Valve Replacement in Preschool Age

林隆煌(Lung-Huang Lin) ； 沈慶村(Ching-Tsuen Shen) ； 蔡朝仁(Chaur-Ren Tsai) ； 朱樹勳(Shu-Hsun Chu) ； 侯書文(Shu-Wen How)

《Acta Paediatrica Sinica》 23卷2期 (1982/06) Pp. 128-134

摘要

本病例係一位6歲女童，因發育不良，常罹患上呼吸道威殺及運動後喘息，經心導管檢查後確證爲中度的僧帽瓣閉鎖不全及左心室舒張終期壓昇高，經4年之定期複診，並利用毛地黃及利尿劑亦無法完全控制心臟衰竭現象，而且出出心房纖維性顫動，於是利用牛心瓣膜置換病人之僧帽瓣膜。術後半年複診，顯示心臟功能良好。謹以報告。

並列摘要

Congenital mitral insufficiency occurs as an isolated lesion of occurs frequently in association with congestive cardiomyopathy, or patent ductus arteriosus, coarctation of the aorta, ventricular septal defect, corrected transposition of the great arteries, anomalous origion of the left coronary artery from the pulmonary artery and endocardial fibroelastosis.A 6-year-old female girl was noted to have heart disease at the age of 1 year. Because of poor weight gain, repeated upper respiratory tract infections and exertional dyspnea, she was admitted for six times to the Cathay General Hospital. Physical examination at the last admission revealed a girl of chronically ill appearance with shortness of breath. A grade 3/6 pansystolic blowing murmur was heard at the apex. The liver was palpable 6 cm below the right costal margin. Chest X-ray films showed a markedly enlarged heart. Electrocardiograms showed atrial fibrillation with a ventricular rate of 80/min, left atrial enlargement and left ventricular hypertrophy. The echocardiogram showed poor LV function and the systolic time interval was PEP=0.12sec, LVET=0.28sec, PEP/LVET=0.42.Cardiac catheterization and angiocardiograms showed mitral regurgitation of moderate severity and elevation of the left ventricular end-diastolic pressure to 18mmHg.Despite the intensive medical treatment, the congestive heart failure was not improved. Surgical replacement of the mitral valve with a 23mm bovine valve was performed. The 6 month postoperative course was smooth. Postoperative echocardiographic exqminations revealed that the left ventricular function returned nearly to normal.

並列關鍵字

Congenital mitral insufficiency ； atrial fibrillation ； chorda tendinea ； papillary muscle