自身免疫反应与复发性生物假体肺瓣膜功能障碍的处理

Q4 Medicine

JACC. Case reports Pub Date : 2025-09-24 DOI:10.1016/j.jaccas.2025.105142

Francis E. Ezekwueme MD , Bryan H. Goldstein MD , Carley Bright DO , Michael Mathier MD , Luciana DaSilva MD , Merritt L. Fajt MD , Anita Saraf MD, PhD

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引用次数: 0

摘要

生物假体瓣膜衰竭是心脏病患者中一种显著且衰弱的后遗症，主要由心内膜炎、钙化和血栓引起的瓣膜小叶结构改变引起。病例总结：我们描述了一个罕见的病例生物假体肺瓣膜失败，由于过敏反应在阀笼内钼。我们描述临床表现，导致诊断的临床方法和治疗进展，直到我们可以解决症状和瓣膜功能的显着恢复。在排除感染性病因后，我们使用皮肤过敏试验确定钼为过敏剂。在免疫抑制和抗组胺药物治疗下，患者的症状和瓣膜功能得到改善和稳定。对一种阀门金属部件过敏，被诊断为皮肤过敏，用免疫抑制和抗组胺药治疗。

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Autoimmune Reaction and the Management of Recurrent Bioprosthetic Pulmonary Valve Dysfunction

Background

Bioprosthetic valve failure is a significant and debilitating sequela in cardiac patients caused primarily by structural changes in valve leaflets due to endocarditis, calcification, and thrombosis.

Case Summary

We describe a rare case of bioprosthetic pulmonary valve failure due to an allergic reaction to molybdenum within the valve cage. We describe the clinical presentation, clinical methods leading to the diagnosis, and treatment progression until we could resolve symptoms and a significant return of valvular competency.

Discussion

After excluding infectious etiologies as a cause, we used skin allergy testing to identify molybdenum as the allergic agent. The patient's symptoms and valve function improved and stabilized with immunosuppression and antihistamines.