The importance of secondary mitral valve involvement in primary aortic valve endocarditis -: The mitral kissing vegetation
The importance of secondary mitral valve involvement in primary aortic valve endocarditis -: The mitral kissing vegetation
复制标题
DOI：
10.1053/euhj.2001.2689
复制
发表时间：
2002-01-01
影响因子：
39.3
通讯作者：
Horstkotte, D
中科院分区：
文献类型：
--
作者：
Piper, C;Hetzer, R;Horstkotte, D
目的原发性主动脉瓣心内膜炎继发二尖瓣病变已有文献报道。一个考虑不充分但可能很重要的致病机制，涉及两个左侧瓣膜，是“二尖瓣吻状赘生物”。这是由于大的主动脉赘生物脱垂到左心室流出道，并与二尖瓣前叶的心室方面接触，从而引起继发性感染。2到18岁（7.6 +/- 2.6）对每例患者进行了一系列经食管超声心动图检查，以证明二尖瓣吻部赘生物的发展，19例（9.9%）主动脉瓣心内膜炎患者的二尖瓣瓣叶初始功能正常，形态正常。二尖瓣对吻赘生物在初次经食管超声心动图检查后11.6 ± 9.0（范围1-31）天内被诊断。在所有二尖瓣对吻赘生物患者中，赘生物附着在主动脉瓣尖上>6 mm。主动脉瓣心内膜炎伴二尖瓣对吻赘生物的患者更常出现脓毒症评分阳性、栓塞事件、肾衰竭，并且主动脉瓣赘生物更大（9.9 ± 3.3 mm vs 5.7 ± 2.3 mm）。主动脉瓣心内膜炎合并二尖瓣对吻赘生物预后不良（P
Aims Secondary involvement of the mitral valve is well documented in primary aortic valve endocarditis. A poorly considered, but probably important, causative mechanism, involving both left-sided valves, is 'mitral kissing vegetation'. This results from large aortic vegetations prolapsing into the left ventricular outflow tract and making contact with the ventricular aspect of the anterior mitral leaflet thus causing secondary infection.Methods and Results In 192 consecutive patients with aortic valve endocarditis, two to 18 (7.6 +/- 2.6) serial transoesophageal echocardiographic examinations were analysed per patient to demonstrate the development of mitral kissing vegetation on initially competent, morphologically normal mitral leaflets, In 19 patients (9.9%) with aortic valve endocarditis. mitral kissing vegetation was diagnosed within 11.6 +/- 9.0 (range 1-31) days following primary transoesophageal echocardiography, In all patients with mitral kissing vegetation, vegetations attached to aortic cusps, were >6 mm. On hospital admission. patients with aortic valve endocarditis plus mitral kissing vegetation presented more often with a positive sepsis score, embolic events, renal failure and had larger aortic valve vegetations (9.9 +/- 3.3 vs 5.7 +/- 2.3 mm). Prognosis of aortic valve endocarditis plus mitral kissing vegetation was unfavourable (P