Valvular Heart Disease 心脏瓣膜病类型讲解 ValvularHeartDisease心脏瓣膜病类型讲解 心脏瓣膜病 是指心瓣膜及瓣下装置由于炎症、变性、粘连、缺血性坏死、创伤、老化或钙质沉着及先天性发育异常等原因,使单个或多个瓣膜发生急性或慢性的狭窄或关闭不全,导致前向血流障碍和/或返流的一组疾病。临床上最常受累的为二尖瓣,其次为主动脉瓣。 风湿性心脏病 简称风心病,仍是我国主要的心脏病,是风湿性炎症过程所致瓣叶损害。根据人群发病率调查已有下降趋势。 ValvularHeartDisease心脏瓣膜病类型讲解 Mitral valve disease 二尖瓣疾病 ValvularHeartDisease心脏瓣膜病类型讲解 Mitral stenosis (MS) 二尖瓣狭窄 ValvularHeartDisease心脏瓣膜病类型讲解 Etiology and Pathology(病因和病理) Rheumatic heart disease (风湿性心脏病) Congenital malformation (先天性畸形) Senile mitral annulus and subvalvular calcification (老年人二尖瓣环及环下区钙化) ValvularHeartDisease心脏瓣膜病类型讲解 Pathophysiology(病理生理) The cross-sectional area of the mitral valve orifice (瓣环口面积) Normal adults 4 - 6cm² Mild MS ≤2cm² Moderate MS ≤² Severe MS ≤² ValvularHeartDisease心脏瓣膜病类型讲解 The effect on LA and cardiac output of MS Mild MS:LA压力轻度升高,心排血量正常 Severe MS:跨瓣压差增大(20mmHg) →LA压力升高(25mmHg);休息时心排血量正常或减少 The effect on the pulmonary circulation and respiration of elevated left atrium pressure ValvularHeartDisease心脏瓣膜病类型讲解 LA →PVP、PCP →lung congestion /pulmonary edema pulmonary artery intima hyperplasia and thickening (肺动脉内膜增生肥厚) PAP(肺动脉压升高) Right heart failure(右心衰竭) ValvularHeartDisease心脏瓣膜病类型讲解 Remarks (备注) PAP:肺动脉压 PCP:肺毛细血管压 PVP肺静脉压 ValvularHeartDisease心脏瓣膜病类型讲解 Clinical situation(临床表现) 一、Symptom (中度狭窄始出现症状) Exertion dyspnea(劳力性呼吸困难) Hemoptysis(咯血) 支气管静脉压↑破裂出血 肺梗死 肺水肿 ValvularHeartDisease心脏瓣膜病类型讲解