ECHOCARDIOGRAPHIC FINDINGS AND CLINICAL-FEATURES OF LEFT-VENTRICULAR PSEUDOANEURYSM AFTER MITRAL-VALVE REPLACEMENT
ECHOCARDIOGRAPHIC FINDINGS AND CLINICAL-FEATURES OF LEFT-VENTRICULAR PSEUDOANEURYSM AFTER MITRAL-VALVE REPLACEMENT
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DOI：
10.1016/0002-8703(92)90981-z
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发表时间：
1992-10-01
影响因子：
4.8
通讯作者：
HOSODA, S
中科院分区：
文献类型：
--
作者：
SAKAI, K;NAKAMURA, K;HOSODA, S
本文分析二尖瓣置换术后左室假性动脉瘤的超声心动图表现及临床特点。1979年12月至1991年3月，我院共施行二尖瓣置换术1050例，其中左室假性动脉瘤8例（0.8%）。所有8例患者均在第二次二尖瓣置换术后发生左心室假性动脉瘤。在253例二尖瓣手术患者中，左室假性动脉瘤的发生率为3.1%。8例患者中有7例仍然存活，随访时间为5 ~ 136个月（平均57个月），这些患者均无并发症。1例患者尽管修复了左心室假性动脉瘤，但仍因二尖瓣置换术后心输出量低而死亡。该患者在左心室假性动脉瘤附近有长而宽的心肌撕裂伤。在其他7例患者中，经胸超声心动图显示了一个大的室外腔沿着后基底左心室。在这些患者中的五个，湍流在颈部的左心室假性动脉瘤记录在收缩期和舒张期的脉冲和彩色多普勒超声心动图。经食道超声心动图清楚地显示了左心室假性动脉瘤的狭窄颈部和左心室与左心室假性动脉瘤之间的异常血流。二尖瓣置换术后发生左室假性动脉瘤时，外科手术是首选的治疗方法。然而，我们的研究表明，左心室假性动脉瘤的发展并不总是与不手术干预的预后不良。因此，有必要通过超声心动图研究观察左心室假性动脉瘤的大小以及颈部的任何异常血流。
We studied the echocardiographic findings and clinical features of left ventricular pseudoaneurysm after mitral valve replacement. From December 1979 to March 1991, 1050 patients underwent mitral valve replacement at our institute, and eight patients (0.8%) had left ventricular pseudoaneurysm. In all eight patients, left ventricular pseudoaneurysm developed after the second mitral valve replacement. The incidence of left ventricular pseudoaneurysm among 253 patients who had had previous mitral valve surgery was 3.1%. Seven of the eight patients were still alive and were followed up from 5 to 136 months (mean, 57 months) after the development of left ventricular pseudoaneurysm; these patients had no complications. One patient died as a result of low cardiac output after mitral valve replacement in spite of repair of the left ventricular pseudoaneurysm. This patient had a long and wide myocardial laceration near the left ventricular pseudoaneurysm. In the other seven patients, transthoracic echocardiography demonstrated a large extraventricular cavity along the posterobasal left ventricle. In five of these patients, a turbulent flow in the neck of the left ventricular pseudoaneurysm was recorded both in systole and diastole by pulsed and color Doppler echocardiography. Transesophageal echocardiography clearly showed the narrow neck of the left ventricular pseudoaneurysm and an abnormal flow between the left ventricle and the left ventricular pseudoaneurysm. Generally, when left ventricular pseudoaneurysm develops after mitral valve replacement, surgical repair is the first choice of therapy. Our study demonstrated, however, that the development of left ventricular pseudoaneurysm was not always associated with a poor prognosis without surgical intervention. Thus it is necessary to observe the size of the left ventricular pseudoaneurysm and any abnormal flow in the neck with echocardiographic studies.