Zhongshan Hospital , Fudan University Zhongshan Hospital , Fudan University
Shanghai Cardiovascular Disease InstitutShanghai Cardiovascular Disease Institute
Guan Lihua, Zhou Daxin, Ge Junbo Guan Lihua, Zhou Daxin, Ge Junbo
Patient Demographics and Patient Demographics and Medical HistoryMedical History
Male, 69 yearsMale, 69 years
Coronary artery angiography: normalCoronary artery angiography: normal
Hypertention: YHypertention: Y
Clinical PresentationClinical PresentationRecurrent chest oppression and tachypnea for 29 years,
aggravate 3 years
1980s diagnosised as rheumatic heart diease
17th, Aug, 1999s, mechanical prosthetic valve replacement of MV and AV
7th, Sep, 1999s, pacemaker implantation because of AF complicated with long pause
Recurrent edema of lower limbs 1year
Physical examinationBP 140/80mmHg , HR 82bpm, AF Engorgement of Jugular vein , enlarged dullness of
heart, L2-3 III SM, L3-4 DM, R2-3 DM Moist rales of bilateral lungsSlight edema of both lower limbs.
Doppler Ultrasound14th, Sep, 1999s, enlarged LA 、 LV 、 RA,
LA49*59mm , LV59mmLV59mm , RA43mm 。 LVEF62%
12th, Oct, 2006s, stenosis and medium-severe perivalvular leakage of aotic mechanical valve. LA42mm , LV55mmLV55mm , RA52mm. PAsP51mmHg.
19th, Oct, 2009s , medium-severe perivalvular leakage of aotic mechanical valve between right coronary sinus and no-coronary sinus . PAsP69mmHg with medium regurgitation of TV , LA48mm , LV61mmLV61mm, RA39mm , enlarged RV , LVEF58%。
angiographyPerivalvular leakage ø6mm*8mm, severe
regurgitation
14mm blockage
Doppler Ultrasound
Slight remanent aortic perivalvular leakage
PAsP 40mmHg
thanksthanks