风湿性二尖瓣置换术后左心室假性室壁瘤形成15例文献复习

Left Ventricular Pseudo-Aneurysm After Rheumatic Mitral Valve Replacement:Literature Review of 15 Cases

目的回顾性分析风湿性二尖瓣置换术(RMVR)术后左心室假性室壁瘤(LVPA)形成的临床特征、影像学表现、治疗与转归。方法检索并收集总结1980年1月—2020年10月在PubMed、万方和CNKI上发表的相关文献。结果选取符合条件的文献18篇,共15个病例。其中,女性占86.7%(13/15),中位年龄62岁(33~75岁)。以二尖瓣狭窄为主(7/15,46.7%),是RMVR术前最常见的瓣膜病变。73.3%(11/15)的患者在RMVR术中安置机械瓣,植入瓣膜直径为27 mm(25~35 mm)。73.3%(11/15)的患者有二次RMVR史。LVPA的诊断时间常在RMVR术后2.5个月(10 d~9年)。2/3的LVPA患者表现为非特异性症状或无症状。最常见的初步筛查工具是超声心动图(12/15,80.0%)。LVPA的位置最常见于左心室后内侧壁(10/15,66.7%),瘤颈最常出现在二尖瓣环(10/15,66.7%),瘤颈直径为1.0 cm(0.3~3.0 cm),瘤腔最大横径为4.0 cm(1.1~12.2 cm)。53.3%(8/15)患者手术修补LVPA,46.7%(7/15)患者选择保守治疗。总死亡率为20.0%(3/15)。结论女性、高龄、二尖瓣狭窄、安置机械瓣和二次RMVR史与LVPA的形成有关。在RMVR术后半年内建议使用经胸/经食管超声心动图密切随访。外科修复是LVPA的推荐治疗方法,但对于小型慢性无症状的LVPA患者,保守随访亦是一种替代方法。

Objective To retrospectively analyze the clinical features,imaging,treatment and outcome of left ventricular pseudo-aneurysm(LVPA)after rheumatic mitral valve replacement(RMVR).Methods This article retrieved,collected and summarized relevant literature published on PubMed database,WanFang Data,and the CNKI from January 1980 to October 2020.Results A total of 15 cases were evaluated from 18 articles.Wherein 13 females(86.7%)and 2 males(13.3%)with a median age of 62 years old(range 33 to 75 years old).Rheumatic mitral valve(MV)stenosis(7/15,46.7%)is the most common valve disease before RMVR.73.3%(11/15)of the patients received a mechanical valve implanted during RMVR,the diameter of the implanted valve was 27 mm(25~35 mm).73.3%(11/15)of patients underwent secondary RMVR.The time of LVPA diagnosis is usually 2.5 months after RMVR(10 days~9 years).2/3 of the patients with LVPA often presented as non-specific symptoms or asymptomatic.The most common initial screening tool was echocardiography(12/15,80.0%).The location of LVPA was most common in the posterior medial wall of the left ventricle(10/15,66.7%),and the location of the LVPA orifice was most often found in the MV ring(10/15,66.7%),the ostium diameter was 1.0 cm(range 0.3~3.0 cm),and the maximum diameter of the tumor was 4.0 cm(range 1.1~12.2 cm).53.3%(8/15)patients had surgical repair of LVPA,46.7%(7/15)patients chose conservative treatment,and the overall mortality rate was 20.0%(3/15).Conclusion Female,advanced age,MV stenosis,placement of mechanical valve,and history of secondary RMVR were related to the formation of LVPA.It is recommended to use transthoracic/transesophageal echocardiography for close follow-up within half a year after RMVR.Surgical repair is the recommended treatment for LVPA,but for small chronic asymptomatic LVPA patients,conservative follow-up is also an alternative method.