Table1_Mitral valve aneurysms: echocardiographic characteristics, formation mechanisms, and patient outcomes.xlsx

BackgroundThe accurate etiology of mitral valve aneurysm (MVA) formation is not completely understood, and the most effective management approach for this condition remains controversial.
MethodsWe retrospectively analyzed 20 MVA patients who underwent either surgical interventions or conservative follow-ups at the Zhongnan Hospital of Wuhan University between 2017 and 2021. We examined their clinical, echocardiographic, and surgical records and tracked their long-term outcomes.
ResultsOf the 20 patients, 12 were diagnosed with MVA using transthoracic echocardiography, seven required additional transesophageal echocardiography for a more definitive diagnosis, and one child was diagnosed during surgery. In all these patients, the MVAs were detected in the anterior mitral leaflet. We found that 15 patients (75%) were associated with infective endocarditis (IE), whereas the remaining patients were associated with bicuspid aortic valve and moderate aortic regurgitation (AR) and mild aortic stenosis (5%), congenital heart disease (5%), elderly calcified valvular disease (5%), mitral valve prolapse (5%), and unknown reasons (5%). Of the 17 patients who underwent hospital surgical interventions, two died due to severe cardiac events. The remaining 15 patients had successful surgeries and were followed up for an average of 13.0 ± 1.8 months. We observed an improvement in their New York Heart Association functional class and mitral regurgitation and AR degrees (P-value < 0.001). During follow-up, only one infant had an increased left ventricular end-diastolic diameter and left ventricular end-systolic diameter, whereas the remaining 14 patients had decreased values (P < 0.001). In addition, none of the three conservatively managed patients experienced disease progression during the 7–24 months of follow-up.
ConclusionsWe recommend using echocardiography as a highly sensitive method for MVA diagnosis. Although most cases are associated with IE or AR, certain cases still require further study to determine their causes. A prompt diagnosis of MVA in patients using echocardiography can aid in its timely management.

背景 二尖瓣瘤（mitral valve aneurysm, MVA）形成的确切病因尚未完全阐明，该疾病的最优管理方案仍存在争议。
方法 本研究回顾性分析了2017年至2021年间，于武汉大学中南医院接受手术治疗或保守随访的20例二尖瓣瘤患者。我们查阅了其临床、超声心动图及手术记录，并对患者的长期预后进行了追踪。
结果 20例患者中，12例经胸超声心动图（transthoracic echocardiography）确诊为二尖瓣瘤，7例需追加经食管超声心动图（transesophageal echocardiography）以明确诊断，1例儿童患者于术中确诊。所有患者的二尖瓣瘤均位于二尖瓣前叶。本研究发现，15例（75%）患者合并感染性心内膜炎（infective endocarditis, IE）；其余患者的病因分别为二叶式主动脉瓣伴中度主动脉瓣反流（aortic regurgitation, AR）及轻度主动脉瓣狭窄（5%）、先天性心脏病（5%）、老年钙化性瓣膜病（5%）、二尖瓣脱垂（5%）及不明原因（5%）。17例接受手术治疗的患者中，2例因严重心脏事件死亡；剩余15例手术成功，平均随访时长为13.0±1.8个月。我们观察到，患者的纽约心脏协会心功能分级、二尖瓣反流及主动脉瓣反流程度均得到改善（P<0.001）。随访期间，仅1例婴儿的左心室舒张末期内径与左心室收缩末期内径出现升高，其余14例患者的上述指标均有所下降（P<0.001）。此外，3例接受保守治疗的患者在7~24个月的随访期内均未出现疾病进展。
结论 我们推荐将超声心动图作为诊断二尖瓣瘤的高灵敏度检测手段。尽管多数二尖瓣瘤病例与感染性心内膜炎或主动脉瓣反流相关，但仍有部分病例的病因有待进一步研究明确。通过超声心动图对患者进行二尖瓣瘤的早期诊断，有助于及时开展该疾病的临床管理。