TTE联合TEE诊断主动脉瓣二瓣畸形致二尖瓣前叶瘤1例报告及文献复习

doi:10.13481/j.1671-587X.20240529

摘要/Abstract

摘要：

目的分析二尖瓣瘤（MVA）的临床表现、影像学特征、治疗措施和疗效，提高临床医师对MVA的认识。方法收集1例主动脉瓣二瓣畸形导致二尖瓣前叶瘤形成患者的临床资料，根据其临床特点和影像学特征明确临床诊断、选择治疗方法并对疗效进行分析，同时进行相关文献复习。结果患者，女性，68岁，因心慌气短13年，加重1个月入院。患者于13年前无诱因出现心慌气短，在当地医院诊断为“心脏瓣膜病”，1个月前上述症状加重而住院治疗。经胸二维超声心动图（TTE）显示左心室肥大，主动脉瓣呈二瓣，瓣叶增厚，回声增强，主动脉瓣前向血流速度增快，瓣口面积2.0 cm²；二尖瓣前叶瓣缘局部略增厚，回声略增强，呈囊性“蜂窝状”结构，与主动脉瓣反流束密切相关，反流束似进入“囊袋”。术前经食管超声心动图（TEE）显示主动脉瓣二瓣畸形，前方瓣叶舒张期脱向左心室流出道；二尖瓣前叶心房面可探及“囊袋状”结构，随心动周期囊壁形态发生改变，该“囊袋”与左心室血流相交通。超声诊断为主动脉瓣二瓣畸形-横裂式、重度关闭不全伴轻度狭窄和二尖瓣前叶瘤。术中主动脉瓣瓣环扩大，瓣叶呈明显关闭不全，将瓣叶切除，主动瓣位置换1枚23号生物瓣；经主动脉瓣口探查二尖瓣，前叶瓣体可探及 “囊袋样”结构，未进行特殊处理。术后TEE显示主动瓣位生物瓣回声及活动良好，二尖瓣“囊袋状”结构仍然不变。术后10 d和术后4个月随访显示主动瓣位生物瓣回声及活动良好，二尖瓣囊性病变的性质及大小与术前比较无明显变化。结论 MVA临床罕见，TTE是目前临床诊断MVA最有价值的影像学诊断方式，特别是TTE联合TEE是最佳诊断方法，且可协助治疗及疗效评价。

关键词: 经胸二维超声心动图, 经食管超声心动图, 主动脉瓣二瓣畸形, 二尖瓣瘤, 疗效评价

Abstract:

Objective To analyze the clinical manifestations， imaging characteristics， treatment measures， and efficacy of mitral valve aneurysm （MVA）， and to enhance the clinicians’ understandings of MVA. Methods The clinical data of one patient with aortic valve bicuspid malformation leading to mitral valve anterior leaflet aneurysm were collected. The clinical diagnosis was confirmed based on the clinical characteristics and imaging features， the treatment methods were selected， and the efficacy was analyzed. The relevant literatures were reviewed. Results The patient， a 68-year-old female， was admitted due to palpitations and shortness of breath for 13 years， and the symptoms worsened one month ago. Thirteen years ago， the patient experienced palpitations and shortness of breath without any inducement and was diagnosed with “heart valve disease” in the local hospital. The symptoms worsened one month ago， leading to hospitalization. The transthoracic two-dimensional echocardiography （TTE） results showed the left ventricular hypertrophy， bicuspid aortic valve with thickened and echogenic leaflets， the forward flow velocity was increased， and the aortic valve orifice area was 2.0 cm2； the mitral valve anterior leaflet margin was slightly thickened and echogenic， presenting a cystic “honeycomb-like” structure closely related to the aortic valve regurgitation jet， which appeared to enter the “sac”. The preoperative transesophageal echocardiography （TEE） results showed the bicuspid aortic valve malformation with the anterior leaflet prolapsing into the left ventricular outflow tract during diastole； a “sac-like” structure was detected on the atrial surface of the mitral valve anterior leaflet， changing shape with the cardiac cycle and communicating with left ventricular blood flow. The ultrasound diagnosis was bicuspid aortic valve malformation with transverse fissure， severe regurgitation with mild stenosis， and mitral valve anterior leaflet aneurysm. Intraoperatively， the aortic valve annulus was enlarged with the significant leaflet regurgitation. The leaflets were excised， and a 23 mm bioprosthetic valve was implanted in the aortic position. Upon exploration through the aortic valve orifice， a “sac-like” structure was found on the mitral valve anterior leaflet， which was not specially treated. The postoperative TEE results showed good echo and activity of the aortic bioprosthetic valve， and the “sac-like” structure on the mitral valve remained unchanged. The follow-up results at 10 d and 4 months after operation showed good echo and activity of the aortic bioprosthetic valve， and compared with before operation， there was no significant change in the nature and size of the mitral valve cystic lesion. Conclusion MVA is clinically rare. TTE is currently the most valuable imaging diagnostic method for MVA， especially when combined with TEE， which is the best diagnostic method and can assist in the treatment and efficacy evaluation.

Key words: Transthoracic echocardiography, Transesophageal echocardiography, Bicuspid aortic valve, Mitral valve aneurysm, Efficacy evaluation

中图分类号:

R543.1

闫岩,郭锋,杨四宝,石少敏. TTE联合TEE诊断主动脉瓣二瓣畸形致二尖瓣前叶瘤1例报告及文献复习[J]. 吉林大学学报(医学版), 2024, 50(5): 1426-1431.

Yan YAN,Feng GUO,Sibao YANG,Shaomin SHI. Diagnosis of bicuspid aortic valve malformation resulting in anterior mitral aneurysm by TTE combined with TEE: A case report and literature review[J]. Journal of Jilin University(Medicine Edition), 2024, 50(5): 1426-1431.

图/表 4

参考文献 25

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