6心脏瓣膜病 -j见习课件 (2).pptVIP

TI临床表现 症状: 重者有右心衰竭症状 并发症--房颤、肺栓塞 体征： 右心衰竭体循环淤血征：颈静脉怒张、肝大腹水、水肿 心脏：三尖瓣区S3，全收缩期高调吹风样杂音，三尖瓣脱垂者为收缩期喀喇音 TI实验室和其他检查 X线检查：RA明显增大，RV、上腔静脉和奇 静脉扩大。可有胸腔积液 心电图：RA增大、不完全性右束支传导阻滞和心 房颤动 超声心动图：有助病因诊断 放射性核素心室造影： TI治疗 内科治疗： 无肺动脉高压无需手术 处理右心衰竭 外科治疗： 其它瓣膜病 心脏听诊有相应的杂音，超声心动图可确定诊断 肺动脉瓣狭窄（Pulmonary stenosis）多为先天性、风湿性少见 肺动脉关闭不全(Pulmonary Incompetence)多为相对性、继发于肺动脉高压或肺动脉扩张 多瓣膜病 多瓣膜病：是指同时累及2个瓣膜或以上的心瓣膜病。也称联合瓣膜病。 它的表现视病变组合而异，血流动力学改变一般较单瓣膜病变严重。 多瓣膜病 瓣膜损害程度相同，近端掩盖远端 瓣膜损害程度不同，重者掩盖轻者 常见的多瓣膜病为二尖瓣和主动脉瓣联合病变 多瓣膜病 MS+AR：最常见组合 MS+AS AS+MR：最危险组合 AR+MR 三瓣膜病变 35 * 22 * FIGURE 46–1. Rheumatic mitral stenosis. A, Moderate valvular changes including diffuse leaflet fibrosis, commissural fusion, and chordal thickening and fusion. In another patient, an atrial view (B) and subvalvular and aortic aspects (C) show prominent subvalvular involvement; severe subvalvular distortion is evident (arrow). D, Severe rheumatic mitral stenosis with specimen shown in apical four-chamber echocardiographic view, demonstrating small left ventricle (lv) and enlarged left atrium (la), right ventricle (rv), and right atrium (ra). Note the calcified stenotic valve (arrow) and prominent subvalvular changes (double arrows). (A and D from Schoen FJ, St. John Sutton M: Contemporary issues in the pathology of valvular heart disease. Hum Pathol 18:568, 1987 * * * * * FIGURE 8–18. A, Pulmonary blood flow redistribution. Enlargement of the upper lobe vessels is seen in a patient with ischemic cardiomyopathy and elevated pulmonary venous pressure. B, Pulmonary interstitial edema. The vessels are indistinct and enlarged, and peribronchial cuffing is present. C, Pulmonary alveolar edema in a patient with congestive cardiomyopathy. The central perihilar distribution of edema, termed “bat wing” edema, is typical of pulmonary alveolar edema caused by cardiovascular or fluid overload (uremic). D, Preferential right upper lobe distribution of pulmonary edema in