Espinola-Zabaleta Nilda, Yabur-Espitia Mirna
Instituto Nacional de Cardiología Ignacio Chávez.
Arch Cardiol Mex. 2010 Apr-Jun;80(2):113-8.
Congenital anomalies of the mitral valve (CAMV) comprise a wide range of leaflet anomalies and of the subvalvular apparatus. Its presentation in adults is not frequent.
In this work, we assessed the clinical and echocardiographic aspects as well as the treatment of five adult patients with CAMV.
A complete clinical history was made for each patient. All patients were subjected to an electrocardiogram, Chest X-rays, and an echocardiogram.
Two patients were in functional class (FC) I, one in FC II, and two in FC III of the New York Heart Association. Diagnoses were: 1) prolapsed mitral valve with severe mitral failure, 2) parachute mitral valve associated with a subvalvular aortic fibrous ring and patent ductus arteriosus, 3) tri-leaflet mitral valve with subaortic obstruction, 4) double mitral orifice associated with bicuspid aorta and aortic coarctation, and 5) tunnel-forming mitral valve associated with ostium primum interatrial communication and pulmonary arterial hypertension and pulmonary artery hypertension. One patient was subjected to mitral valve change, one to dilation of the aortic coarctation, and another is under sitaxentan treatment, with improvement in the FC. The two remaining patients are awaiting surgery.
Review of these cases with CAMV reveals the relevance of the echocardiogram in the evaluation of the mitral valve and of the subvalvular apparatus, because it allows for the identification of different types of malformations and their hemodynamic repercussion, to be able to propose the precise and timely treatment for these patients.
二尖瓣先天性异常(CAMV)包括多种瓣叶异常和瓣下结构异常。其在成人中的表现并不常见。
在本研究中,我们评估了5例成年二尖瓣先天性异常患者的临床和超声心动图特征以及治疗情况。
为每位患者进行了完整的临床病史采集。所有患者均接受了心电图、胸部X线和超声心动图检查。
两名患者心功能分级(FC)为I级,一名为II级,两名患者为纽约心脏协会III级。诊断结果如下:1)二尖瓣脱垂伴严重二尖瓣功能不全;2)降落伞样二尖瓣伴瓣下主动脉纤维环和动脉导管未闭;3)三叶二尖瓣伴主动脉瓣下狭窄;4)双二尖瓣口伴二叶式主动脉瓣和主动脉缩窄;5)隧道样二尖瓣伴原发孔房间隔缺损、肺动脉高压。一名患者接受了二尖瓣置换术,一名患者接受了主动脉缩窄扩张术,另一名患者正在接受西他生坦治疗,心功能分级有所改善。其余两名患者正在等待手术。
回顾这些二尖瓣先天性异常病例发现,超声心动图在评估二尖瓣和瓣下结构方面具有重要意义,因为它能够识别不同类型的畸形及其血流动力学影响,从而能够为这些患者提出准确及时的治疗方案。