Kanazawa I, Eno S, Nakayama K, Ishibashi K, Ozono R, Fujii H, Maruhashi A, Morita S, Maeda Y, Nishida T
Department of Internal Medicine, Chugoku Rosai Hospital.
Kokyu To Junkan. 1992 Sep;40(9):927-31.
Aneurysms of the mitral valve complicating infective endocarditis (IE) are uncommon. The patient was a 57-year-old man who was admitted to our hospital for a precise examination of heart failure. One year before, the first two-dimensional echocardiography showed an aneurysm of the anterior mitral leaflet possibly due to a previous attack of IE. Doppler color flow mapping detected a regurgitant jet from the mitral valve aneurysm into the left atrium during systole, which suggested perforation of the aneurysm, and an aortic regurgitant jet flowing against the anterior mitral leaflet. Because the patient's family refused cardiac catheter examination and surgery, we treated him in the out-patient clinic. A few weeks before his admission, he had discontinued taking diuretics because of uncomfortable urinary frequency. He gradually developed the symptoms of heart failure and entered our hospital. IE was suspected because of leucocytosis and slight fever. Two-dimensional echocardiography revealed a new aneurysm of the anterior mitral leaflet without perforation, located in the distal part of the old aneurysm. This time, his family consented to the surgical treatment. Aortic and mitral valve replacement was successfully performed. It was pathologically confirmed that the two mitral aneurysms had been caused by IE.
二尖瓣瘤并发感染性心内膜炎（IE）并不常见。该患者为一名57岁男性，因心力衰竭接受精确检查入院。一年前，首次二维超声心动图显示二尖瓣前叶瘤，可能是既往IE发作所致。多普勒彩色血流图检测到收缩期二尖瓣瘤有反流束进入左心房，提示瘤体穿孔，还有一股主动脉反流束冲击二尖瓣前叶。由于患者家属拒绝心脏导管检查和手术，我们在门诊对其进行治疗。入院前几周，他因尿频不适而停用利尿剂。他逐渐出现心力衰竭症状并入院。因白细胞增多和低热怀疑患有IE。二维超声心动图显示二尖瓣前叶出现一个新的未穿孔瘤，位于旧瘤体的远端。此次，其家属同意手术治疗。成功进行了主动脉瓣和二尖瓣置换术。病理证实两个二尖瓣瘤均由IE引起。
