Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3695_Библиотеки_им_академика_М_И_Перельмана

E.V., a 62-year-old white woman with systemic hypertension and diabetes mellitus, had 4 cardiac valve operations (Table 1). Congestive heart failure developed during her second pregnancy and 1 year later, at age 35, she underwent closed mitral commissurotomy for mitral stenosis. She was nearly asymptomatic for 2 years thereafter and then congestive heart failure and atrial brillation developed. Because of worsening congestive heart failure, at age 46 she had simultaneous replacement of both native mitral and tricuspid valves with Hancock no. 29 and 31 glutaraldehype processed bioprostheses, respectively. She was asymptomatic for the next 8years when congestive heart failure reappeared at age 54. Left ventricular cineangiogram now demonstrated 4+/4+ mitral regurgitation and a 22mm Hg mean diastolic pressure gradient across the bioprosthesis in the mitral position. At age 54, the 2 bioprostheses, each of which had been in place for 100 months, were excised along with the diffusely thickened, purely regurgitant aortic valve and all 3 were replaced with Hancock bioprostheses. The excised bioprosthesis in the mitral position had heavier calcic deposits than did the bioprothesis in the tricuspid valve position (Figure1). Postoperatively, she again was asymptomatic. Catheterization, 7 months later, disclosed a 11mm Hg mean diastolic pressure gradient across the bioprosthesis in the mitral position. Pulmonary hypertension persisted. Congestive heart failure recurred at age 61years, 86 months after the last operation. Nine months later or 3 days before death the 3 bioprosthetic valves were replaced because of refractory congestive heart failure. The bioprosthesis that had been in the tricuspid valve position had heavier calcic deposits than that present on the bioprostheses that had been in either the mitral or aortic valve position (Figure2).