内科学瓣膜性心脏病教学.pptVIP

* Types of aortic valve stenosis. A, Normal aortic valve. B, Congenital aortic stenosis. C, Rheumatic aortic stenosis. D, Calcific aortic stenosis. E, Calcific senile aortic stenosis. (From Brandenburg RO, et al: Valvular heart disease—When should the patient be referred? Pract Cardiol 5:50, 1979.) Four types of calcific aortic stenosis. In each, the unopened aortic valve is viewed form above. A. Acquired bicuspid aortic valve with secondary calcification. At the center of the conjoined cusp (lower center) are elements of two preexisting cusps, now fused. B. Congenital bicuspid valve. The characteristic raphe of the congenital bicuspid aortic valve appears at the lower portion of the figure. C. Senile type. None of the commissures is fused, but there is a major intrinsic calcification of the three cusps. D. Unicuspid, unicommissural congenital aortic stenosis with secondary calcification. JE Edwards: Pathology of acquired valvular disease of the heart. Semin Roentgenol 14:96, 1979. * Aortic stenosis lead to LV outflow obstruction. The major compensatory mechanism by which the hear copes with LV outflow obstruction is ventricular hypertrophy. * Normal heart size with dilated proximal ascending aorta(poststenotic dilation). Calcification of aortic valve may be present as a hallmark of AS Concentric hypertrophy of LV, no change of LV size on chest film. But lV wall thickening may be detected on echo. Eccentric hypertrophy may be present in the late stage of AS. * Echocardiogram recorded in a patient with severe aortic stenosis. The top panel is a parasternal long-axis view recorded in systole. Left ventricular function is diminished. The aortic valve is markedly thickened and partially calcified. Its motion is markedly reduced and in systole it appears that the valve occludes the orifice (arrow). The lower panel is a continuous-wave Doppler recorded from the apex of the left ventricle along a line aimed through the stenotic aortic valve. Note the aortic s