Silbiger Jeffrey J
Mount Sinai School of Medicine, New York, USA.
J Heart Valve Dis. 2009 Sep;18(5):476-80.
The mitral valve frequently becomes secondarily infected in aortic valve endocarditis. A number of mechanisms have been invoked to explain this association, including: (i) aortic regurgitation (jet lesions); (ii) vegetation prolapse into the left ventricular outflow tract ('kissing lesions'); and (iii) a contiguous spread of infected tissue. A variety of secondary lesions can develop on the mitral valve, including partial thickness ulcerations, perforations, vegetations, and aneurysms. The clinical recognition and treatment of mitral valve aneurysms in primary aortic valve endocarditis are of particular interest and comprise the main focus of this review. Echocardiographically, mitral valve aneurysms appear as narrow-necked, saccular echolucencies protruding into the left atrium. These structures must be distinguished from mitral valve prolapse, congenital diverticula and blood cysts. Mitral regurgitation can result from aneurysm perforation or from the mass effect produced by lesions critically located along the lines of leaflet closure. Aneurysms harboring clot are a potential source of systemic embolization. Treatment is generally surgical; however, otherwise uncomplicated aneurysms have been safely followed using a more conservative strategy.
二尖瓣在主动脉瓣心内膜炎时常常继发感染。人们提出了多种机制来解释这种关联，包括：（i）主动脉反流（喷射性病变）；（ii）赘生物脱垂至左心室流出道（“亲吻性病变”）；以及（iii）感染组织的连续蔓延。二尖瓣可出现多种继发性病变，包括部分厚度溃疡、穿孔、赘生物和动脉瘤。原发性主动脉瓣心内膜炎中二尖瓣动脉瘤的临床识别与治疗尤其引人关注，也是本综述的主要重点。在超声心动图上，二尖瓣动脉瘤表现为突入左心房的窄颈、囊状无回声区。这些结构必须与二尖瓣脱垂、先天性憩室和血囊肿相鉴别。二尖瓣反流可由动脉瘤穿孔或沿瓣叶闭合线关键部位的病变产生的占位效应引起。含有血栓的动脉瘤是全身栓塞的潜在来源。治疗通常采用手术；然而，对于其他方面无并发症的动脉瘤，采用更保守的策略进行安全随访也是可行的。
