浙江大学精品-心脏瓣膜病.ppt

病 因 风湿性: 常合并关闭不全与二尖瓣病变 先天性: 单叶,二叶或三叶 老年退行性变 The figure shows the masses of lipo-calcification on the aortic side of all three leaflets and the absence of commissural fusion. 病理生理 主动脉瓣狭窄--?左心室肥厚--?左心室扩张 临床表现 呼吸困难 晕厥: 运动时外周血管扩张心排量未能增加,心肌缺血加重,严重的心律失常 心绞痛 猝死 体　征 望诊: 心尖博动增强 触诊: 心尖抬举样博动，主动脉区触及 收缩期震颤 叩诊: 心界可正常或向左下扩大 听诊: 主动脉区SM3/6级以上（响亮粗 糙），喷射性，向颈部传导，A2↓, S2反常分裂,杂音强度与心功能有关 超 声 心 动 图 A two-dimensional echocardiogram from a patient with severe aortic stenosis is shown. A: The long-axis view reveals an echogenic and very immobile aortic valve. B: The corresponding short-axis view suggests a high degree of calcification of the valve and minimal mobility during systole. LA, left atrium; LV, left ventricle; RV, right ventricle. The recording shows a maximum velocity of 6.2m/s corresponding to a maximum gradient of 154mmHg and a mean gradient of 92mmHg The relationship with PG and heart function 并　发　症 心脏性猝死 心衰: 多数是左心衰 心律失常:房颤(耐受性差);室性心律失常 感染性心内膜炎 栓塞:多见于钙化性狭窄 3 内 科 治 疗 无症状的轻度主狭无须特殊处理 中重度主狭避免剧烈运动 定期随访和复查心超 防止感染性心内膜炎和风湿活动 心律失常 心绞痛 心力衰竭:慎用扩血管和利尿剂 Parasternal long-axis view of a patient with mitral stenosis and a pliable noncalcified mitral valve leaflet. Note the “doming” motion of the mitral valve leaflets (arrowheads). Valves with these morphologic features are excellent candidates for percutaneous balloon valvotomy. In the top panel note the diffuse thickening of the mitral valve. The reduced orifice can be seen in this end-diastolic frame (arrow). The bottom panel was recorded in systole and provides a view of the chordal apparatus, which can be seen to be diffusely thickened and fibrotic. Valves with this appearance are less ideal candidates for percutaneous intervention M-mode echocardiogram recorded in a patient with typical mitral stenosis. There is thickening at the leaflets and flattening of the E-F slope. Two-dimensional transthoracic parasternal short-axis view of the mitral valve orifice during