陈珺-心脏瓣膜病.pptVIP

⒊人工心脏瓣膜置换术 生物瓣 使用年限有限10年左右 器械瓣 需终身抗凝治疗 手术条件 ⑴心功能Ⅱ-Ⅲ级 ⑵心功能Ⅰ级伴心脏明显扩大 AI　MI　AS ⑶心功能Ⅳ级需纠正 ⑷全身情况可耐受手术 * 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.) * Malar flush of mitral stenosis. This pinkish-purple discoloration has been attributed to vasoconstriction associated with the low cardiac output of severe mitral stenosis. * Typical malar flush of mitral stenosis. * Chest radiograph of a patient with mitral stenosis shows mild left atrial enlargement with clear lung fields and a normal-size cardiac silhouette. The left atrial appendage bulge is indicated by the white arrow and the double-density due to an enlarged left atrium by the black arrows. * Parasternal long-axis (A) and short-axis (B) two-dimensional echocardiographic views in mid-diastole show the characteristic findings of rheumatic mitral stenosis. The commissural fusion results in doming of the leaflets in the long-axis view (arrow) and in a decreased width of the mitral orifice in the short-axis view. This patient has relatively thin, flexible leaflets with little subvalvular involvement. Ao = aorta; LA = left atrium; LV = left ventricle; MVA = mitral valve area. * Two-dimensional transthoracic parasternal short-axis view of the mitral valve orifice during diastole, demonstrating the echocardiographic meth