经皮球囊扩瓣治疗风湿性心脏病二尖瓣狭窄并三尖瓣狭窄1例

经皮球囊扩瓣治疗风湿性心脏病二尖瓣狭窄并三尖瓣狭窄１例湖北医大附属第一医院心内科（４３００６０）张庆华，江洪，王晋明，漆曙辉患者男性，４４岁，于１９７５年因患风湿性心脏病（ＲＨＤ）行‘二尖瓣交界分离术’。术后能胜任一般体力劳动。１９８５年心电图检查发...     

非风湿性二尖瓣关闭不全成形术后二尖瓣狭窄

非风湿性二尖瓣关闭不全成形术后二尖瓣再次关闭不全是成形手术失败的常见原因,但术后二尖瓣狭窄非常罕见。该文报道了4例因粘液变性或缺血性二尖瓣返流患者二尖瓣成形术后的二尖瓣狭窄。 方法 研究对象为1990年1月～1999年12月行二尖瓣成形术后的478例二尖瓣粘液变性及40例缺血性二尖瓣返流患者。术中、出院前及术后每年均行心脏彩超检查。随访时间12     

老年风湿性二尖瓣中重度狭窄合并主动脉瓣轻中度关闭不全患者行经皮二尖瓣球囊扩张术的疗效

<正>经皮二尖瓣球囊扩张术(PBMV)具有创伤小、疗效佳、相对安全且术后恢复快的优点,使其成为风湿性二尖瓣狭窄的首选治疗方法。在临床中发现老年风湿性二尖瓣狭窄多合并有主动脉瓣关闭不全,外科手术由于创伤高龄等因素多不被患者及其家属接受,因此,PBMV对此类患者显得较为重要。本研究旨在观察老年风湿性二尖瓣狭窄合并主动脉瓣关闭不全患者进行PBMV的疗效。1资料与方法1.1受试对象我院住院的风湿性二尖瓣中重度狭窄合并主     

风湿性心脏病患者二尖瓣轻度狭窄与二尖瓣重度狭窄者免疫功能的变化

目的 探讨风湿性心脏病(RHD)者二尖瓣轻度狭窄与重度狭窄者细胞免疫功能的变化及特点.方法 分为二尖瓣轻度狭窄者32例(A组),重度狭窄者22例(B组).用流式细胞仪检测患者外周血T淋巴细胞亚群.用液相终点散射免疫沉淀法检测RHD血清免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)、补体3(C3)、补体4(C4).用聚乙二醇法测血清循环免疫复合物(CIC)两组间比较.结果 B组CD3、CD4、CD8、CD19较A组明显低下(P＜0.01).B组IgG、IgA、IgM、C3、C4、CIC较A组高,但无统计学差异.结论 B组细胞免疫功能低于A组.     

风湿性心脏病，二尖瓣狭窄

二尖瓣狭窄的病因?风湿性心脏病。什么叫风湿热?风湿热是一种对链球菌软组织感染(咽峡炎)的全身性炎性反应。     

妊娠并风湿性心脏病二尖瓣狭窄患者经皮球囊成形术疗效观察

S 目的:探讨经皮球囊二尖瓣成形术(percutaneous balloon mitral valvuloplasty,PBMV)在妊娠合并风湿性心脏病二尖瓣狭窄患者中的安全性、可行性及术后对妊娠的影响。     

风湿性心脏病二尖瓣狭窄患者左房血栓形成的多因素回归分析

目的 :探讨风湿性心脏病二尖瓣狭窄 (风心二狭 )患者左房血栓形成的临床相关因素。方法 :6 9例风心二狭患者行经胸及食管超声心动图检查 ,并用发色底物显色法测定血浆组织型纤溶酶原激活物 (t PA )、组织型纤溶酶原激活物抑制物 1(PAI- 1)及抗凝血酶 (AT- )活性。结果 :33例风心二狭左房血栓形成组与 36例无血栓组比较 ,年龄偏大 ,症状持续时间较长 ,心房颤动发生率高 ;超声心动图显示左房内径较大 ,左室射血分数较低 ,二尖瓣口面积较小 ,明显二尖瓣关闭不全少见 ,左房自发性回声 (SEC)发生率明显增高 ;血液学检查显示红细胞压积较高 ,AT- 活性较低 t PA活性较高 ,PAI- 1活性较低。多元回归分析表明左房 SEC、AT- 活性、年龄、二尖瓣口面积大小是左房血栓形成的独立相关因素。结论 :风心二狭患者左房血栓的形成不仅与血流的局部机械性梗阻淤滞 ,而且与机体抗栓能力的下降有关。     

风湿性心脏病二尖瓣狭窄经皮二尖瓣成形术后肺通气功能观察

国内外学者报道风湿性心脏病二尖瓣病变患者换瓣术后 6～ 1 2月肺功能能得到改善。本文对1 6例风湿性心脏病二尖瓣狭窄患者进行经皮二尖瓣扩张术 (PBMV)前后作心肺功能的观察 ,现将结果报告如下。1　资料与方法1 997年 8月至 1 999年 4月经超声心动图确诊为风湿性心脏病二尖瓣狭窄 (MS) ,在我院行PBMV术患者 1 6例。其中男性 9例 ,女性 7例 ,年龄 2 2～ 5 5岁 (平均 3 3 .4± 7.2岁 ) ,病程 3～ 1 2年 (平均 6 .8± 3 .2年 ) ,心脏功能 (NYHA标准 ) 级 2例 , 级 1 1例 , 级 3例。合并轻度二尖瓣关闭不全 (MR) 6例 ,轻度主动脉瓣关闭…     

风湿性二尖瓣狭窄置换术术后恢复与二尖瓣环运动速率的关系

目的 探讨风湿性二尖瓣狭窄（MS）患者二尖瓣环运动速率与二尖瓣置换术术后恢复情况的相关性。方法 44例接受二尖瓣置换术的风湿性单纯MS患者分为恢复良组和恢复差组,术前、术后多普勒组织成像（DTI）技术检测二尖瓣环射血期、舒张早期峰值速率Vs、Ve;术中取乳头肌组织行心肌病理学检查。比较两组间各指标的差异。结果 术前、术后平均Vs和术前平均Ve均表现为恢复良组显著大于恢复差组,恢复差组心肌纤维化比例显著高于恢复良组,余指标组间无显著性差异。结论 单纯MS时二尖瓣置换术术后恢复情况与二尖瓣环速率、心肌纤维化程度相关,提示DTI可用于无创判断二尖瓣置换术预后。     

风湿性心脏病二尖瓣狭窄左心房大小与房颤关系

目的　探讨风湿性心脏病 (RHD)二尖瓣狭窄者左心房大小与房颤的关系。方法　对RHD二尖瓣狭窄的 30 1例分为A组 (房颤组 )和B组 (非房颤组 ) ,采用彩色多普勒显像仪检测两组左房大小 ,统计左心房大小均数标准差。结果　左房前后径A组 (5 4 2± 7 32 )mm ,B组 (4 5 5± 6 0 0 )mm(P <0 0 1)。A组中合并有中度或重度二关瓣狭窄、关闭不全者 ,其左房前后径为 (5 8 5 9± 10 6 1)mm ,其余为 (5 1 5 8± 8 0 7)mm (P <0 0 1)。结论　RHD二尖瓣狭窄病者伴房颤的左心房内径较无房颤组大 ,提示左房增大与房颤发生关系密切。     

Anomalous coronary artery origin associated with bicuspid aortic valve in a patient with rheumatic mitral stenosis: a case report

A rare case of an anomalous left coronary artery arising from the right sinus of Valsalva associated with bicuspid aortic valve is presented. This case is unique because these congenital anomalies were associated with rheumatic mitral stenosis. This anomalous coronary origin was found at catheterization before balloon mitral valvuloplasty. The clinical significance of this finding is discussed.     

Doppler sonography quantification of mitral valve stenosis in patients with and without mitral valve insufficiency

Fifty-three patients with mitral stenosis (MS) were examined by two dimensional (2DE) and Doppler echocardiography (Dop). Twenty-nine of them also had mitral insufficiency (MI) as judged by Dop. The mitral valve area (MVA) was calculated from Doppler using the "pressure half time" and was compared with MVA by 2 DE. There was a good correlation between both methods in all 53 patients (r = 0.88; SEE = 0.34 cm2) but also in the subgroups with pure MS (r = 0.86; SEE = 0.29 cm2) and MS + MI respectively (r = 0.90; SEE = 0.38 cm2). The accuracy and the reproducibility of the Doppler method was highly dependent on the severity of the stenosis. In 19 cases with mild MS (MVA by 2 DE greater than 1.5 cm2) the absolute difference between MVA 2 DE and Dop averaged 0.39 cm2. The difference between the maximal and minimal Doppler MVA which reflects the variability of this method averaged 0.65 cm2 in this group. In cases with significant MS (MVA by 2 DE less than or equal to 1.5 cm2) the average difference 2 DE -Dop and Dop max-Dop min was only 0.20 cm2 and 0.27 cm2 respectively. In patients with comparable degrees of stenosis additional MI did not adversely affect the accuracy of the Doppler method. We conclude that Doppler echo allows an accurate quantitation of mitral stenosis even in patients with associated MI.     

Assessment of mitral valve volume by quantitative three-dimensional echocardiography in patients with rheumatic mitral valve stenosis

Background: Thickening of mitral leaflets in rheumatic mitral valve stenosis is well described in necropsy studies; however, volume computation of the thickening mitral leaflets has not been attempted. Atrial fibrillation is one of the complications of rheumatic mitral stenosis. Quantitative assessment of thickened mitral valve and its relation to clinical complications is clinically desirable. Hypothesis: The study was undertaken to compare measurement of mitral valve volume in normal subjects and in patients with rheumatic mitral valve stenosis. Methods: An HP Sonos 2500 echocardiography system with 5 MHz multiplane transesophageal transducer was used for data acquisition, and TomTec Echoscan computer setup was used to off-line volume computation. Study subjects included 10 normal subjects (mean age 44.8 years) and 36 patients with rheumatic mitral valve stenosis (22 female, 14 male) with an age range of 25 to 69 years (mean age 47 $pL 9.6 years). Mitral valve volumes were compared between the normal subjects and patients with mitral valve stenosis, and further comparison was made between the sinus rhythm (SR) and atrial fibrillation (AF) groups in patients with mitral valve stenosis. In all study subjects, the mitral valve area (MVA) was determined by two-dimensional echocardiography. Results: Quantitative three-dimensional (3-D) echocardiography showed that mitral valve volume was significantly larger in patients with mitral valve stenosis than in normal subjects (9.0 $pL 2.2 and 4.5 $pL 0.7 ml, respectively, p<0.001). When patients with mitral valve stenosis were divided into the SR and AF groups, mitral valve volume was found to be significantly larger in the AF group than in the SR group (9.76 $pL 2.2 ml.and 7.72 $pL 1.5 ml, respectively, p < 0.01) and patients in the AF group tended to be older (p < 0.05) with larger left atrial diameter (LAD) (p<0.01). However, MVA between the two groups showed no statistical significance (1.1 $pL 0.43 and 1.0 $pL 0.34 cm², respectively, p >0.2). When the study subjects were divided into two groups (< 50 and > 50 years) according to age, the comparison of mitral valve volume between these two groups (9.37 $pL 2.18 and 8.56 $pL 2.14 ml, p >0.2) showed no statistical significance. Conclusions: Quantitative 3-D echocardiography can be applied for the measurement of mitral valve volume in vivo. Patients with rheumatic mitral valve stenosis with atrial fibril lation have a propensity to have a larger mitral valve volume and are older than the patients with sinus rhythm; however, the age per se does not seem to be a cause for larger mitral valve volume.     

A rare association of Ebstein's anomaly of tricuspid valve with rheumatic mitral stenosis

Mitral valve abnormalities have been described in Ebstein's anomaly, but acquired rheumatic mitral valve disease is an extremely rare association. We describe a classical case of Ebstein's anomaly of tricuspid valve with severe rheumatic mitral stenosis. This patient had mild mitral regurgitation, pulmonary hypertension and atrial fibrillation.     

Congenital uni‐leaflet mitral valve with severe stenosis: A case report with literature review

Numerical abnormalities of mitral leaflets is a special entity in congenital mitral malformations. Previously reported cases of uni‐leaflet mitral valve were primarily related to absence or dysplasia of certain leaflets. We present a case here with mitral leaflets that were not divided into anterior and posterior as usual, but developed as an integral structure instead, which is different from previously documented cases of uni‐leaflet mitral valves. Real time three‐dimensional echocardiography (RT3DE) provides a visual presentation of the abnormal mitral structure which was confirmed by surgical operation. To the best of our knowledge, this unusual form of uni‐leaflet mitral valve has not been reported yet.