二尖瓣前叶腱索与乳头肌交界血性囊肿一例分析

Blood cyst at junction between chordae tendineae of anterior mitral valve leaflet and papillary muscle in patients with partial endocardial cushion defect：one case report

目的探讨二尖瓣前叶腱索与乳头肌交界血性囊肿的临床及病理学特点，提高对血性囊肿的认识，及时作出诊疗，进一步探索其形成原因。方法回顾性分析1例部分型心内膜垫缺损合并二尖瓣前叶腱索与乳头肌交界血性囊肿10岁男孩的临床资料，总结诊疗经验，并结合相关报道进行文献复习。本例术前经胸心脏超声未见肿块，二尖瓣口收缩期可见轻中度偏心性反流血流信号及湍流血流信号，缩流径宽3．0mm。术中开胸前食道心脏超声探查始见二尖瓣区大小约11．2mm×7．9mm的中等稍强回声光团。结果患儿术后恢复良好，复查心脏彩色超声提示二尖瓣口收缩期可见轻度偏心性反流血流信号及湍流血流信号，缩流径宽2．2mm，未吸氧动脉血气分析氧分压为95mmHg，经皮血氧饱和度为99％，均较术前有改善。术后6个月随访，患儿无明显自觉不适，复查未吸氧动脉血气分析氧分压为98mmHg，经皮血氧饱和度为99％，行食道心脏超声二尖瓣区未见异常团块声像，二尖瓣口收缩期可见轻度偏心性反流血流信号及湍流血流信号，缩流径宽1．5mm，EF：70％。结论瓣膜装置血性囊肿，尤其二尖瓣前叶腱索与乳头肌交界血性囊肿临床不多见。对于部分型心内膜垫缺损患儿合并二尖瓣前叶腱索与乳头肌交界血性囊肿应同期处理，对于单独二尖瓣前叶腱索与乳头肌交界血性囊肿的治疗，目前尚无确切一致的指南，仅在有临床症状时予相应处理，否则定期观察即可。

Objective To explore the clinicopathological characteristics of blood cyst at junction between chordae tendineae of anterior mitral valve leaflet and papillary muscle so as to make an accurate diagnosis timely and elucidate its etiology. Methods Retrospective analyses were performed for the clinical data of a 10-year-old boy of partial endocardial cushion defect （PECD） with blood cyst at junction between chordae tendineae of anterior mitral valve leaflet and papillary muscle. Results The postoperative recovery was excellent. A re-examination of echocardiography revealed mild eccentric regurgitation and turbulent flow signals were detected during systolic period. Vena contraeta was 3.0 ram. Arterial blood gas analysis showed oxygen partial pressure was 95 mmHg and transcutaneous oxygen saturation 99% during no oxygen supplementation. And there were postoperative improvements. During 6-month follow-ups, no obvious discomforts were found. Arterial blood gas analysis showed oxygen partial pressure was 98 mmHg and transcutaneous oxygen saturation 99% during no oxygen supplementation. Transesophageal echocardiography showed no abnormality of mitral valve area. Mild eccentric regurgitate and turbulent flow signals were detected during systolic period. Vena contracta was 1.5 mm and ejection fraction 70%. Conclusions Blood cyst of mitral valve equipment, especially at junction between chordae tendineae of anterior mitral valve leaflet and papillary muscle, is rare in clinical practice. Cyst and PECD should be treated simultaneously for a solitary cyst without any intracardiac lesions. Currently there is no consensus guideline. Symptomatic measures and regular observations are sufficient.