天津医科大学内科学课件 Mitral Stenosis.pptVIP

MS -Pathophysiology MS -Pathophysiology MS -Clinical Presentation MS-Severe MS-MVR（Tissue） ?Valvular Heart Disease  Mitral Stenosis Xin Du, MD Cardiovascular Centre Mitral Stenosis (MS) MS -Etiology Predominant cause: Rheumatic fever Thickening, shortening, adhering, calcium depositing, and scarring Four forms of fusion: (1) commissural, (2) cuspal, (3)chordal, (4)combined Two types of shape: fish-mouth shaped, funnel-shaped Rare causes: congenital, prosthetic valve stenosis, mitral annular calcification MS -Pathophysiology Normal valve area: 4~6 cm2 Mild MS: Mitral valve area 2 cm2, Mean gradient 5 mm Hg, LAP↑→LA↑, compensated period Moderate MS: 1.5 cm2, 5 ~10 mm Hg, PVP↑, PCWP↑ → interstitial edema Severe MS: 1.0 cm2, 10 mm Hg, PAP↑→RV overload → RV failure →TR →PR Cough Hoarseness (Ortner’s syndrome, a harsh, rough quality to the voice due to paralysis of the left recurrent laryngeal nerve caused by a dilated left atrium in MS) MS -Clinical Presentation Signs: -Mitral facies: a plum-colored malar flush, occurs only when cardiac output is low and pulmonary hypertension is severe; cause is cutaneous vasodilation and chronic hypoxemia -Diastolic thrill at apex -S1↑(flexible), Opening Snap , Diastolic rumbling murmur at apex -P2↑, splitting, Graham Steell murmur(a high pitched early diastolic murmur audible along the left sternal border due to functional PR),TR Mitral facies MS -Clinical Presentation Laboratory Examinations -Electrocardiography: 1) Left atrial enlargement: P wave (II,V1) 2) Atrial fibrillation 3) Right ventricular hypertrophy - Echocardiography: M-mode, 2-D, Doppler, Real-time 3D - Chest X-ray: LAA and LA enlargement, increased upper lobe vascularity, Kerley B and A lines, dilated PA, MV calcificationA lines MS -X-ray Echo 3-D Echo of MS MS -Differential Diagnosis Diastolic rumbling murmur at apex + X-film + ECG + Echo Relative MS; Austin-Flint murmur (a mid-dias