Güler Ahmet, Hatipoğlu Suzan, Karabay Can Yücel, Kırma Cevat
Department of Cardiology, Kartal Koşuyolu Heart and Research Hospital, İstanbul, Turkey.
Turk Kardiyol Dern Ars. 2011 Dec;39(8):690-2. doi: 10.5543/tkda.2011.01671.
Perforation of a mitral valve aneurysm is a rare cause of acute mitral regurgitation, and valvular aneurysm formation and its rupture without infectious involvement are unusual. An 80-year-old man was admitted with acute onset and progressive dyspnea. He had no history of chest pain, palpitation, or fever. Laboratory findings did not suggest any signs of infection. Transthoracic echocardiography revealed an aneurysm of the mitral septal leaflet protruding into the left atrium during systole and color-flow Doppler ultrasonography showed severe mitral regurgitation. There was no aortic regurgitation nor evidence for rheumatic involvement of the valvular structures. Pulmonary artery systolic pressure estimated from the tricuspid regurgitation jet was 50 mmHg. Transesophageal echocardiography showed a saccular, thin-walled, mitral valve aneurysm on the atrial surface, expanding during systole and a small tissue defect on the aneurysmatic segment of the mitral leaflet. There were no signs of connective tissue disease. The patient was submitted to surgery. The aneurysmatic and perforated parts on the septal leaflet were resected and an annuloplasty ring was placed. The histopathological examination of the mitral valve tissue showed nonspecific degenerative changes. The postoperative period was uneventful and the patient was discharged on the fifth postoperative day.
二尖瓣动脉瘤穿孔是急性二尖瓣反流的罕见原因，瓣膜动脉瘤形成及其无感染累及的破裂并不常见。一名80岁男性因急性起病和进行性呼吸困难入院。他无胸痛、心悸或发热病史。实验室检查结果未提示任何感染迹象。经胸超声心动图显示二尖瓣隔叶动脉瘤在收缩期突入左心房，彩色多普勒超声心动图显示严重二尖瓣反流。无主动脉反流，也无瓣膜结构风湿累及的证据。根据三尖瓣反流束估测的肺动脉收缩压为50 mmHg。经食管超声心动图显示心房面有一个囊状、薄壁的二尖瓣动脉瘤，在收缩期扩大，二尖瓣叶动脉瘤段有一个小的组织缺损。无结缔组织病迹象。患者接受了手术。切除隔叶上的动脉瘤和穿孔部分，并置入瓣环成形环。二尖瓣组织的组织病理学检查显示非特异性退行性改变。术后过程顺利，患者于术后第5天出院。
