Brenner B, Blumenfeld Z, Markiewicz W, Reisner S A
Department of Hematology, Rambam Medical Center, Haifa, Israel.
J Am Coll Cardiol. 1991 Oct;18(4):931-6. doi: 10.1016/0735-1097(91)90749-y.
To evaluate cardiac involvement in primary antiphospholipid syndrome, two-dimensional and Doppler echocardiographic studies were performed in 34 consecutive patients with this syndrome. All patients had an increased level of serum anticardiolipin antibodies with no evidence of malignancy or systemic lupus erythematosus. The clinical manifestations of primary antiphospholipid syndrome were arterial thrombosis in 14 patients, venous thrombosis in 6 and recurrent fetal loss in 14. Valvular lesions were observed on two-dimensional echocardiography in 11 patients (32%) (9 women and 2 men), aged 24 to 57 years (mean +/- 1 SD 36 +/- 10). Abnormal echocardiographic findings were observed in 9 (64%) of 14 patients with arterial thrombosis versus 1 (17%) of 6 patients with venous thrombosis and 1 (7%) of 14 patients with recurrent fetal loss. The most common echocardiographic abnormality was mitral leaflet thickening, found in five patients; this was associated with mitral regurgitation in three and with combined mild mitral stenosis and regurgitation in one patient. Localized subvalvular mitral thickening was observed in one patient and calcification of the anulus in another. Aortic valve thickening was observed in two patients, one of whom also had a moderate degree of aortic regurgitation. Vegetation-like lesions on the mitral or aortic valve were found in two patients. It is concluded that valvular lesions are commonly found in primary antiphospholipid syndrome, particularly when the syndrome is manifested by peripheral arterial thrombosis. The location and appearance of valvular lesions in this syndrome are heterogeneous. Most patients have no clinically significant valvular disease. Two-dimensional and Doppler echocardiographic studies are often informative in these patients.
为评估原发性抗磷脂综合征中心脏受累情况，对34例连续的该综合征患者进行了二维和多普勒超声心动图研究。所有患者血清抗心磷脂抗体水平升高，无恶性肿瘤或系统性红斑狼疮证据。原发性抗磷脂综合征的临床表现为14例患者出现动脉血栓形成，6例出现静脉血栓形成，14例出现反复流产。二维超声心动图检查发现11例患者（32%）（9例女性和2例男性）有瓣膜病变，年龄在24至57岁之间（平均±1标准差36±10）。14例动脉血栓形成患者中有9例（64%）出现超声心动图异常，而6例静脉血栓形成患者中有1例（17%），14例反复流产患者中有1例（7%）。最常见的超声心动图异常是二尖瓣叶增厚，5例患者出现此情况；其中3例伴有二尖瓣反流，1例伴有轻度二尖瓣狭窄和反流。1例患者观察到二尖瓣瓣下局部增厚，另1例患者观察到瓣环钙化。2例患者出现主动脉瓣增厚，其中1例还伴有中度主动脉反流。2例患者在二尖瓣或主动脉瓣上发现类似赘生物的病变。结论是瓣膜病变在原发性抗磷脂综合征中常见，尤其是当该综合征以周围动脉血栓形成为表现时。该综合征中瓣膜病变的位置和表现具有异质性。大多数患者没有具有临床意义的瓣膜疾病。二维和多普勒超声心动图研究对这些患者通常具有指导意义。
