【翻译】严重的二尖瓣返流（新英格兰医学杂志系列030） | |
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| 1.【翻译】严重的二尖瓣返流（新英格兰医学杂志系列030） | Copy to clipboard |
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Posted by: 约瑟福
Posted on: 2008-03-23 16:38
Severe Mitral Regurgitation
A 45-year-old woman with end-stage renal disease was seen for acute bacterial endocarditis. Echocardiographic study revealed marked mitral regurgitation with a large vegetation on the atrial side of the anterior leaflet of the mitral valve. At coronary angiography, a 30 percent stenosis of the proximal left anterior descending coronary artery and a 70 percent stenosis of the midportion of the right coronary artery were evident. Left ventriculography revealed normal systolic function with grade III/IV mitral regurgitation. The hemodynamic findings were of particular interest. A pulmonary-artery tracing (Panel A) revealed an elevated pulmonary-artery pressure, with a peak early systolic pressure of approximately 70 mm Hg (white arrow) followed by a V wave, which further elevated the pulmonary-artery pressure (black arrow). The pulmonary-capillary wedge pressure (PCWP) tracing (Panel B ) was characterized by a V wave (white arrow) that ranged from 64 to 78 mm Hg. The left ventricular diastolic pressure (LVDP) curve shows that the pressure in the left ventricle was normal from the onset of diastole to the beginning of the A wave (upper black arrow). With atrial contraction, however, there was a marked increase in pressure of 24 mm Hg (the area between the two black arrows). The normal pressure during most of diastole probably explains why the patient did not have pulmonary edema. |
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| 2.Re:【翻译】严重的二尖瓣返流（新英格兰医学杂志系列029） [Re: 约瑟福] | Copy to clipboard |
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Posted by: 约瑟福
Posted on: 2008-03-23 16:39
如图所示：
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| 3.Re:【翻译】严重的二尖瓣返流（新英格兰医学杂志系列029） [Re: 约瑟福] | Copy to clipboard |
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Posted by: 约瑟福
Posted on: 2008-03-23 17:00
45岁，女性，终末期肾病，因急性细菌性心内膜炎就诊。超声心动图显示明显的二尖瓣返流，伴有二尖瓣前叶心房侧大的赘生物。冠脉造影见左前降支近端狭窄30%，右冠中段狭窄70%。左室造影提示收缩功能正常，二尖瓣返流 III/IV级，有趣的是其血流动力学检查结果： 肺动脉压力曲线 (图 A)提示肺动脉压力增高，收缩早期峰压高达70 mm Hg (白色箭头)，紧接其后的是一 V波，肺动脉压力进一步升高 (黑色箭头)。肺毛细血管楔压(PCWP) 图B )显示特征性 V 波 (白色箭头) 在64-78 mm Hg之间。 左心室舒张压(LVDP)曲线显示自舒张期开始到A波开始 (上方黑色箭头)压力正常，而随着心房收缩，压力明显升高达24 mm Hg (两黑色箭头之间区域)。舒张期大部分时间左心室收缩压正常说明该患者没有肺水肿迹象。
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| 4.Re:【翻译】严重的二尖瓣返流（新英格兰医学杂志系列030） [Re: 约瑟福] | Copy to clipboard |
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Posted by: 秦大智
Posted on: 2008-06-01 13:53
谢谢分享
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