浙江大学精品医学课件-心脏瓣膜病.pptVIP

;风 湿 热;流行病学;病因;临 床 表 现;全身症状;主要表现;心脏炎:会造成永久损害，60%-80%;关节炎:不会永久损害;环形红斑;皮下结节;舞蹈病:无后遗症;次要表现;支持甲族乙型链球菌感染的依据;风湿热的诊断：Jones标准;;病 因;病 理;A, 瓣叶纤维化,融合,腱索增厚,融合 B 心房侧 C 显示瓣下结构 D 小心腔大心房, 瓣环钙化,瓣下结构改变;病理生理;3;3;;心电图;A, The left atrial border is prominently convex. The aorta is small in this 19-year-old patient with mitral stenosis (arrow). B, A subtle convex bulge can be noted at the level of the left atrial appendage (open arrow). A double atrial shadow is present on the right atrial border (black arrow), and the heart is not enlarged in this 54-year-old woman with mitral stenosis. C, Mitral stenosis with chronic interstitial pulmonary edema and small punctate opacities representing small islands of ossification within the alveoli. D, Mitral stenosis, right anterior oblique view. This posterior displacement of the barium column is related to the enlarged left atrium. ;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 diastole, demonstrating the echocardiographic method of mitral valve area calculation. The innermost border of the mitral orifice was planimetered with the use of a light-pen system to obtain the area (in cm2 ). ;4;5;6;7