【2017年整理】南昌大学超声精品课程之心脏瓣膜病之一.pptVIP

;一. 病理生理： 二尖瓣炎症，水肿 → 瓣膜增厚、粗糙、粘连、融合 → 瓣口狭窄: (1).隔膜型: 瓣体病变轻,弹性较好. (2).漏斗型 : 粘连增粗并纤维化、钙化→瓣下结构缩短变硬,形成漏斗状.; 二尖瓣口狭窄 → 左房进入左室血流 受阻 → 血流淤积于左房 → 左房 扩大压力升高 → 血流缓慢,左心耳,左 房血栓形成 → 肺静脉,肺毛细血管压 升高 → 肺动脉扩大 → 右室阻力升 高→右室肥厚→右心衰竭. ;二尖瓣口面积4--- 6cm2 二尖瓣口狭窄: 轻度:1.5 — 2cm 2 压差10 mmHg 中度:1.0---1.5 cm2 压差10-20mmHg 重度: 1.0 cm 2 压差20mmHg ;二尖瓣口面积测量;二. 临床表现: 左心衰, 肺水肿.;左 心 长 轴;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;四. 声像图特点:; (3) 风湿侵犯瓣下结构,腱索增粗,缩短 (4) 左房,右室增大,肺动脉内径增宽 (5) 左房,左心耳血栓形成 ;左 心 长 轴; 二狭长轴及血流动态图;左房,左心耳血栓形成 ;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;2.M型超声心动图: (1) . 二尖瓣前后叶活动曲线呈城墙样改 变,EF 斜率减低,A波消失,前后叶呈同向运动. (2) .E峰下降垂直距离6mm 正常人16mm (3) . 瓣膜增强增粗. (4) .心底波群,左房增大;M型超声心动图;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;3.多谱勒超声心动图 (1). 通过狭窄口,血流速度加快,峰值 超过2m,频谱为宽带充填 (2). 彩色多谱勒血流 二尖瓣靠左室侧 见以红色为主的五色镶嵌的血流束. (3). 运用 CW可计算二尖瓣跨瓣压差.;五色镶嵌的血流束;二 狭 血 流 频 谱 图;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;五. 鉴别诊断 (1). 与二尖瓣口血流增多鉴别 : 室间隔缺损, 动脉导管 未闭,主动脉窦瘤破裂,二尖瓣关 闭不全等 (2) 与二尖瓣口面积减小鉴别: 主动脉瓣关闭 不全,心衰,扩心等; 室间隔缺损;Evaluation only. Created with Aspose.Slides fo