目的：二尖瓣-主动脉瓣纤维连结（Mitral-aortic intervalvular fibrosa，MAIVF）受累是感染性心内膜炎的一种少见并发症，本文回顾性总结分析了其超声特点及临床特征。方法：对18例超声心动图诊断感染性心内膜炎MAIVF受累的病例图像回顾性分析，总结其临床特征及超声特点。结果：①MAIVF受累可能好发于伴随先天性主动脉瓣二叶式畸形及结缔组织病的感染性心内膜炎；②MAIVF受累的患者主动脉瓣病变较二尖瓣更为严重；③MAIVF受累可以表现为MAIVF部位的增厚，囊腔形成或局部团块样组织，并可能导致心腔间的分流。结论：超声心动图是感染性心内膜炎MAIVF受累的首选筛查方法，可以评价脓肿大小、形态、位置、周围血流信号及其他感染性心内膜炎并发症，为制定手术方案提供完整的信息。
Abstract
Objective: The destruction of mitral-aortic intervalvular fibrosa(MAIVF) complicated by infective endocarditis is rare, we concluded and analyzed the echocardiographic features and clinical characteristics of these patients retrospectively. Methods: We analyzed echocardiographic materials of 18 cases which were diagnosed by echocardiography of the destruction of MAIVF retrospectively, and summarized their clinical characteristics and echocardiographic features. Results: ①Infective endocarditis complicated with aortic bicuspid valve and connective tissue disease prefers to destroy MAIVF. ②The destruction of aortic valve were worse than mitral valve among these patients. ③The destruction of MAIVF could present as thickning, saccular formation and mass formation, which might cause the shunt between cardiac chambers. Conclusion: Echocardiography is the first choice for screening the destruction of MAIVF in infective endocarditis, which can evaluate the size, shape, location, blood flow of involved MAIVF and other complications of infective endocarditis, provides more detail information for surgery.
关键词
心内膜炎 /
超声心动描记术 /
多普勒 /
彩色
Key words
Endocarditis /
Echocardiography, Doppler, color
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参考文献
[1]Saremi F, Sanchez-Quintana D, Mori S, et al. Fibrous Skeleton of the Heart: Anatomic Overview and Evaluation of Pathologic Conditions with CT and MR Imaging[J]. Radiographics, 2017, 37(5): 1330-1351.
[2]Davierwala PM, Binner C, Subramanian S, et al. Double valve replacement and reconstruction of the intervalvular fibrous body in patients with active infective endocarditis[J]. Eur J Cardiothorac Surg, 2014, 45(1): 146-152.
[3]Bansal RC, Moloney PM, Marsa RJ, et al. Echocardiographic features of a mycotic aneurysm of the left ventricular outflow tract caused by perforation of mitral-aortic intervalvular fibrosa[J]. Circulation, 1983, 67(4): 930-934.
[4]Tribouilloy C, Rusinaru D, Sorel C, et al. Clinical characteristics and outcome of infective endocarditis in adults with bicuspid aortic valves: a multicentre observational study[J]. Heart, 2010, 96(21): 1723-1729.
[5]Sudhakar S, Sewani A, Agrawal M, et al. Pseudoaneurysm of the mitral-aortic intervalvular fibrosa(MAIVF): A comprehensive review[J]. J Am Soc Echocardiogr, 2010, 23(10): 1009-1018.
[6]Pu L, Li R, Xie J, et al. Characteristic Echocardiographic Manifestations of Behcet’s Disease[J]. Ultrasound Med Biol, 2018, 44(4): 825-830.
[7]Koichi S, Kiyoharu N, Akihiko G, et al. Infective endocarditis associated with Sjogren’s syndrome[J]. Asian Cardiovasc Thorac Ann, 2006, 14(6): 115-117.
[8]Morita F, Hirai Y, Suzuki K, et al. Infective endocarditis and Sjogren’s syndrome diagnosed simultaneously[J]. IDCases, 2016, 7: 6-8.
[9]Spadaro GL, Zeppellini R, Rigo T, et al. A rare case of mitro-aortic intervalvular fibrosa aneurysm evolving in the para-aortic cavity[J]. J Cardiovascr Med, 2009, 10(5): 409-411.
[10]Zhao S, Chen X, Yang X. Prenatal diagnosis of an aneurysm of the mitral-aortic intervalvular fibrosa[J]. Echocardiography, 2015, 32(4): 716-719.
[11]Anguera I, Miro JM, Evangelista A, et al. Periannular complications in infective endocarditis involving native aortic valves[J]. Am J Cardiol, 2006, 98(9): 1254-1260.
[12]Sadat K, Joshi D, Sudhakar S, et al. Incremental role of three-dimensional transesophageal echocardiography in the assessment of mitral-aortic intervalvular fibrosa abscess[J]. Echocardiography, 2012, 29(6): 742-744.
[13]Aksoy O, Sexton DJ, Wang A, et al. Early surgery in patients with infective endocarditis: a propensity score analysis[J]. Clin Infect Dis, 2007, 44(3): 364-372.
