[1]徐学萍 蔡琳 黄刚 张扬春 罗勇 熊峰 陈杰 汪汉.风湿性二尖瓣置换术后左心室假性室壁瘤形成15例文献复习[J].心血管病学进展,2021,(6):555.[doi:10.16806/j.cnki.issn.1004-3934.2021.06.019]
　XU Xueping,CAI Lin,HUANG Gang,et al.Left Ventricular Pseudoaneurysm After Rheumatic Mitral Valve Replacement: Literature Review of 15 Cases[J].Advances in Cardiovascular Diseases,2021,(6):555.[doi:10.16806/j.cnki.issn.1004-3934.2021.06.019]
点击复制

风湿性二尖瓣置换术后左心室假性室壁瘤形成15例文献复习()
分享到：

《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2021年6期
页码:
555
栏目:
综述
出版日期:
2021-06-25

文章信息/Info

Title:
Left Ventricular Pseudoaneurysm After Rheumatic Mitral Valve Replacement: Literature Review of 15 Cases
作者:
徐学萍1; 3 蔡琳 1; 3 黄刚 1 张扬春 1 罗勇 2 熊峰1 陈杰 2 汪汉 1; 3
(1.西南交通大学附属医院 成都市第三人民医院心内科,四川 成都 610031;2.西南交通大学附属医院 成都市第三人民医院心脏大血管外科,四川 成都 610031;3.西南交通大学医学院,四川 成都 610031)
Author(s):
XU Xueping1; 3; CAI Lin1; 3; HUANG Gang1; ZHANG Yangchun1; LUO Yong2; XIONG Feng1; CHEN Jie2; WANG Han1; 3
(1.Department of Cardiology,The Third People’s Hospital of ChengduThe Affiliated Hospital of Southwest Jiaotong University,Chengdu 610031,Sichuan,China;2.Department of Cardiovascular Surgery,The Third People’s Hospital of Chengdu,The Affiliated Hospital of Southwest Jiaotong University,Chengdu 610031,Sichuan,China;3.Southwest Jiaotong University College of Medicine,Chengdu 610031,Sichuan,China)
关键词:
左心室假性室壁瘤; 风湿性二尖瓣置换术后; 回顾性研究
Keywords:
Left ventricular pseudo-aneurysm; After rheumatic mitral valve replacement; Retrospective study
DOI:
10.16806/j.cnki.issn.1004-3934.2021.06.019
摘要:
目的 回顾性分析风湿性二尖瓣置换术(RMVR)术后左心室假性室壁瘤(LVPA)形成的临床特征、影像学表现、治疗与转归。方法 检索并收集总结1980年1月—2020年10月在PubMed、万方和CNKI上发表的相关文献。结果 选取符合条件的文献18篇，共15个病例。其中，女性占86.7%（13/15），中位年龄62岁（33～75岁）。以二尖瓣狭窄为主（7/15，46.7%），是RMVR术前最常见的瓣膜病变。73.3%（11/15）的患者在RMVR术中安置机械瓣，植入瓣膜直径为27 mm（25～35 mm）。73.3%（11/15）的患者有二次RMVR史。LVPA的诊断时间常在RMVR术后2.5个月（10 d～9年）。2/3的LVPA患者表现为非特异性症状或无症状。最常见的初步筛查工具是超声心动图（12/15，80.0%）。LVPA的位置最常见于左心室后内侧壁（10/15，66.7%），瘤颈最常出现在二尖瓣环（10/15，66.7%），瘤颈直径为1.0 cm（0.3～3.0 cm），瘤腔最大横径为4.0 cm（1.1～12.2 cm）。53.3%（8/15）患者手术修补LVPA，46.7%（7/15）患者选择保守治疗。总死亡率为20.0%（3/15）。结论 女性、高龄、二尖瓣狭窄、安置机械瓣和二次RMVR史与LVPA的形成有关。在RMVR术后半年内建议使用经胸/经食管超声心动图密切随访。外科修复是LVPA的推荐治疗方法，但对于小型慢性无症状的LVPA患者，保守随访亦是一种替代方法。
Abstract:
Objective To retrospectively analyze the clinical features,imaging,treatment and outcome of left ventricular pseudo-aneurysm (LVPA) after rheumatic mitral valve replacement (RMVR). Methods This article retrieved,collected and summarized relevant literature published on PubMed database,WanFang Data,and the China National Knowledge Infrastructure from January 1980 to October 2020. Results A total of 15 cases were evaluated from 18 articles. Wherein 13 females (86.7%) and 2 males (13.3%) with a median age of 62 years old (range 33 to 75 years old). Rheumatic mitral valve (MV) stenosis (7/15,46.7%) is the most common valve disease before RMVR. 73.3% (11/15) of the patients received a mechanical valve implanted during RMVR,the diameter of the implanted valve was 27 mm (25～35 mm). 73.3% (11/15) of patients underwent secondary RMVR. The time of LVPA diagnosis is usually 2.5 months after RMVR (10 days～9 years). 2/3 of the patients with LVPA often presented as non-specific symptoms or asymptomatic. The most common initial screening tool was echocardiography (12/15,80.0%). The location of LVPA was most common in the posterior medial wall of the left ventricle (10/15,66.7%),and the location of the LVPA orifice was most often found in the MV ring (10/15,66.7%),the ostium diameter was 1.0 cm (range 0.3～3.0 cm),and the maximum diameter of the tumor was 4.0 cm (range 1.1～12.2 cm). 53.3% (8/15) patients had surgical repair of LVPA,46.7% (7/15) patients chose conservative treatment,and the overall mortality rate was 20.0% (3/15). Conclusion Female,advanced age,MV stenosis,placement of mechanical valve,and history of secondary RMVR were related to the formation of LVPA. It is recommended to use transthoracic/transesophageal echocardiography for close follow-up within half a year after RMVR. Surgical repair is the recommended treatment for LVPA,but for small chronic asymptomatic LVPA patients,conservative follow-up is also an alternative method

参考文献/References:

[1]Kasahara H,Beran G,Mohl W. Left ventricular pseudoaneurysm following mitral valve repair[J]. Gen Thorac Cardiovasc Surg,2009,57(4):221-223.

[2]Zhang HJ,Ma WG,Xu JP,et al. Left ventricular rupture after mitral valve replacement:a report of 13 cases[J]. Asian Cardiovasc Thorac Ann,2006,14(1):26-29.

[3]Rainer WG. Rupture of left ventricle following mitral valve replacement[J]. Ann Thorac Surg,1988,46(5):488.

[4]Chatson G,Gallagher R,Quahliero D,et al. Ventricular pseudoaneurysm associated with cardiopulmonary resuscitation 6 weeks after mitral valve replacement[J]. Ann Thorac Surg,1989,48(5):719-720.

[5]Minami KT,Fergusson DJ. Systolic compression of the right coronary artery by a pseudoaneurysm following mitral valve replacement[J]. Cathet Cardiovasc Diagn,1989,18(1):31-35.

[6]Sutter FP,Goldman SM,Werthman PE,et al. Circumflex artery ventricular fistula and pseudoaneurysm after mitral reoperation[J]. Ann Thorac Surg,1990,50(5):826-827.

[7]Ascah KJ,Patrick E,Chilton C,et al. Atypical pseudoaneurysm after mitral valve replacement:Doppler echocardiographic diagnosis[J]. J Am Soc Echocardiogr,1991,4(6):625-630.

[8]Watanabe A,Kazui T,Tsukamoto M,et al. Left ventricular pseudoaneurysm and intracardiac fistulas after replacement of mitral valve prosthesis[J]. Ann Thorac Surg,1993,55(5):1236-1239.

[9]Nomura F,Taniguchi K,Kadoba K,et al. Repair of late left ventricular rupture after repeat mitral valve replacement[J]. Eur J Cardiothorac Surg,1997,11(5):991-993.

[10]Idir M,Deville C,Roudaut R. Delayed left atrial wall dissection after mitral valve replacement[J]. Echocardiography,2000,17(3):259-261.

[11]Suda H,Ikeda K,Doi K,et al. Successful repair of left ventricular pseudoaneurysm after mitral reoperation under hypothermic circulatory arrest[J]. Jpn J Thorac Cardiovasc Surg,2003,51(1):18-20.

[12]Lanjewar C,Thakkar B,Kerkar P,et al. Submitral left ventricular pseudoaneurysm after mitral valve replacement:early diagnosis and successful repair[J]. Interact Cardiovasc Thorac Surg,2007,6(4):505-507.

[13]Matteucci ML,Rescigno G,Capestro F,et al. Delayed left ventricle posterior wall rupture following mitral replacement detected by multislice CT-scan[J]. J Card Surg,2011,26(4):383-384.

[14]覃夏川. 超声诊断二尖瓣置换术后左室假性室壁瘤1例[J]. 西部医学,2011,23(3):427.

[15]Guo HW,Xu JP,Chang Y,et al. Coronary sinus approach to repair an intracardiac ventricular pseudoaneurysm[J]. J Card Surg,2012,27(6):692-695.

[16]周晓辉,许建屏. 二尖瓣机械瓣置换术后左心室假性室壁瘤成功修补一例[J]. 中国循环杂志,2013,28(5):329.

[17]Inoue T,Hashimoto K,Sakamoto Y,et al. Spontaneous closure of a large left ventricular pseudoaneurysm after mitral valve replacement[J]. Gen Thorac Cardiovasc Surg,2016,64(6):337-339.

[18]Neupane S,Kommuri NV,Kazanji N,et al. Left ventricular pseudoaneurysm after mitral valve replacement[J]. Echocardiography,2016,33(11):1788-1789.

[19]Arnaz A,Akansel S,Yalcinbas Y,et al. Transcatheter closure of left ventricular pseudoaneurysm after mitral valve replacement[J]. Ann Thorac Surg,2020,110(2):e123-e125.

[20]Sahan E,Sahan S,Karamanlioglu M,et al. Left ventricular pseudoaneurysm after mitral valve replacement:review of pseudoaneurysms late after mitral valve replacement[J]. Herz,2015,40(5):778-782.

[21]Meng X,Yang YK,Yang KQ,et al. Clinical characteristics and outcomes of left ventricular pseudoaneurysm:a retrospective study in a single-center of China[J]. Medicine (Baltimore),2017,96(18):e6793.

[22]Bassan R,Jasbik W,de Souza MA,et al. Subvalvular left ventricular pseudoaneurysm:a rare complication of mitral valve replacement[J]. Cathet Cardiovasc Diagn,1981,7(3):269-273.

[23]Sakai K,Nakamura K,Ishizuka N,et al. Echocardiographic findings and clinical features of left ventricular pseudoaneurysm after mitral valve replacement[J]. Am Heart J,1992,124(4):975-982.

[24]Fishbein GA,Fishbein MC. Mitral valve pathology[J]. Curr Cardiol Rep,2019,21(7):61.

[25]Pretre R,Linka A,Jenni R,et al. Surgical treatment of acquired left ventricular pseudoaneurysms[J]. Ann Thorac Surg,2000,70(2):553-557.

[26]Antonic M,Djordjevic A,Mohorko T,et al. Left ventricular pseudoaneurysm following atrioventricular groove rupture after mitral valve replacement[J]. SAGE Open Med Case Rep,2019,7:2050313X18823456.

[27]Sobczyk WL,Jones JW,Mcmanus BM. Clinically occult "false-on-true" left ventricular aneurysm:association with late sudden death following mitral valve replacement[J]. Am Heart J,1986,112(5):1090-1092.

更新日期/Last Update: 2021-07-23