经胸联合经食管超声心动图诊断左心室流出道赘生物合并二尖瓣副瓣1例  

Left ventricular outflow tract vegetation with accessory mitral valve diagnosed by transthoracic and transesophageal echocardiography:a case report

作　　者：蔡银港 冯海艳[1] 王琳琳[1] 闫岩[1] 孙丽娜[1] Cai Yingang;Feng Haiyan;Wang Linlin;Yan Yan;Sun Lina(Department of Ultrasound,China-Japan Union Hospital of Jilin University,Changchun 130000,China)

机构地区：[1]吉林大学中日联谊医院超声科,长春130000

出　　处：《中华超声影像学杂志》2025年第1期52-55,共4页Chinese Journal of Ultrasonography

基　　金：吉林省技术服务项目(2023YX0007)。

摘　　要：二尖瓣副瓣(AMV)指正常二尖瓣上连接额外的瓣膜结构成分,是一种罕见的先天性心血管系统畸形,发病率约为1/26000。大多数患者症状不明显,常因合并其他心脏畸形而接受超声心动图检查偶然发现,其合并左心室流出道赘生物极为罕见,可能与感染性心内膜炎有关。本例患者男,48岁,因脑梗死在外院治疗期间发现“心脏肿物”,遂来吉林大学中日联谊医院进一步诊疗。患者近3个月间断发热,活动量大时伴有胸闷胸痛,既往有痛风和糖尿病病史。经胸超声心动图和经食管超声心动图显示左心室流出道梗阻,二尖瓣副瓣(膜样固定型),左心室流出道内室间隔侧占位性病变。最终经手术切除及术后病理确诊为(左心室流出道)赘生物,二尖瓣副瓣,术后经胸超声心动图显示左心室流出道内流速和压差显著降低。超声心动图具有简便、无创、可重复性等优势,能够直观地观察二尖瓣副瓣及其他心脏异常,评估瓣膜功能和血流动力学变化,并可评估左心室流出道梗阻情况,便于术前诊断和术后随访,是诊断二尖瓣副瓣的金标准。Accessory mitral valve(AMV)refers to the additional valvular structural components connected to the normal mitral valve.It is a rare congenital cardiovascular malformation with an incidence of approximately 1/26000.Most patients have no obvious symptoms and are often accidentally detected during echocardiography due to the presence of other associated cardiac malformations.The combination of AMV with left ventricular outflow tract(LVOT)vegetations is extremely rare and may be related to infective endocarditis.In this case,a 48-year-old male patient was discovered to have a"cardiac mass"during treatment for a cerebral infarction at an external hospital and was admitted to China-Japan Union Hospital of Jilin University for further diagnosis and treatment.Over the past 3 months,the patient experienced intermittent fever,accompanied by chest tightness and pain during physical exertion.The patient had a history of gout and diabetes.Transthoracic echocardiography(TTE)and transesophageal echocardiography revealed left ventricular outflow tract obstruction,accessory mitral valve(membranous fixed type),and a space-occupying lesion on the ventricular septal side within the left ventricular outflow tract.The final diagnosis of vegetation in the left ventricular outflow tract and accessory mitral valve was confirmed through surgical resection and postoperative pathology.Postoperative TTE showed a significant reduction in the flow velocity and pressure gradient within the left ventricular outflow tract.Echocardiography,with its advantages of simplicity,non-invasiveness,and repeatability,allows for the direct observation of accessory mitral valve and other cardiac abnormalities,evaluation of valve function and hemodynamic changes,and assessment of the left ventricular outflow tract obstruction condition.It facilitates preoperative diagnosis and postoperative follow-up,serving as the gold standard for diagnosing accessory mitral valve.

关 键 词：超声心动描记术 经胸 超声心动描记术 经食管 二尖瓣副瓣 左心室流出道赘生物 

分 类 号：R540.45[医药卫生—心血管疾病] R541[医药卫生—内科学]