Li Y H, Lin J M, Lei M H, Wang T L, Ma H M, Hwang J J, Kuan P, Lien W P
Department of Internal Medicine, National Taiwan University Hospital, Taipei, ROC.
J Formos Med Assoc. 1995 Aug;94(8):499-502.
From March 1992 to March 1994, four cases of mitral valve aneurysm were diagnosed at National Taiwan University Hospital. Mitral valve infective endocarditis was documented in three patients, while aortic valve infective endocarditis was found in the other. The diagnosis of mitral valve aneurysm was based on characteristic echocardiographic findings. The mitral valve aneurysms in these four cases were all visualized by transesophageal but not transthoracic echocardiography. At the time of diagnosis, three patients with a history of mitral valve endocarditis had perforated mitral valve aneurysms and severe mitral regurgitation. Although not found before surgery, the remaining patient with a history of aortic valve endocarditis was noted to have an unperforated mitral valve aneurysm one month after aortic valve replacement. All three patients with severe mitral regurgitation underwent mitral valve replacement and the patient with an unperforated mitral valve aneurysm was managed conservatively and obtained a stable clinical condition. In conclusion, mitral valve aneurysm usually appears to be associated with infective endocarditis and transesophageal echocardiography is more helpful in the diagnosis of mitral valve aneurysm than transthoracic echocardiography. Furthermore, unperforated mitral valve aneurysms may be managed conservatively with careful follow-up.
1992年3月至1994年3月期间，台湾大学医院诊断出4例二尖瓣动脉瘤。3例患者被记录有二尖瓣感染性心内膜炎，另1例则患有主动脉瓣感染性心内膜炎。二尖瓣动脉瘤的诊断基于特征性的超声心动图表现。这4例患者的二尖瓣动脉瘤均经食管超声心动图而非经胸超声心动图显示。在诊断时，3例有二尖瓣心内膜炎病史的患者存在二尖瓣动脉瘤穿孔及严重二尖瓣反流。尽管术前未发现，但1例有主动脉瓣心内膜炎病史的患者在主动脉瓣置换术后1个月被发现有未穿孔的二尖瓣动脉瘤。所有3例有严重二尖瓣反流的患者均接受了二尖瓣置换术，而未穿孔二尖瓣动脉瘤患者接受了保守治疗，临床状况稳定。总之，二尖瓣动脉瘤似乎通常与感染性心内膜炎相关，经食管超声心动图在二尖瓣动脉瘤的诊断中比经胸超声心动图更有帮助。此外，未穿孔的二尖瓣动脉瘤可通过仔细随访进行保守治疗。
