老年人钙化性心脏瓣膜病临床与超声对照研究

老年人钙化性心脏瓣膜病(SCHVD)已引起临床界的高度重视.老年人的主动脉瓣疾病主要由瓣膜硬化和钙化引起.二尖瓣膜和(或)二尖瓣环的钙化,足以导致二尖瓣关闭不全和(或)二尖瓣狭窄.若病变心肌扩展和钙化涉及传导系统,尚能并发心脏扩大、心力衰竭、心律失常,甚至猝死.我们自1989年以来,共检出119例SCHVD,现把临床与超声心动图(UCG)资料对照分析,进一步探讨SCHVD的超声诊断和临床意义.     

老年性主动脉瓣钙化的超声表现及危险因素研究

目的 分析老年性主动脉瓣钙化的超声表现及其危险因素。方法 回顾性研究3000例50岁以上患者的心脏超声心动图检查结果，重点观察主动脉瓣的钙化情况；分析老年性主动脉瓣钙化与年龄、性别及高血压病的关系；对32例严重钙化的瓣膜进行病理观察。结果 ≥65岁组与50—65岁组，按年龄分组后男女性别及有无高血压各组间比较，主动脉瓣钙化检出率有统计学意义；老年性主动脉瓣钙化位置主要在瓣体。结论 高龄、男性、高血压病等是主动脉瓣钙化的危险因素；老年性主动脉瓣膜钙化以瓣体病变为主。     

超声诊断老年退行性心瓣膜病变的特点及意义

目的：探讨彩色多普勒超声心动图对老年性退行性心瓣膜病变的诊断特点、临床应用及对临床治疗的指导意义。材料与方法：对来我院进行心脏超声体检者年龄在45~90岁的635例人群进行彩色多普勒超声心动图检查,观察房室大小,瓣膜及瓣环的形态改变、活动的状态,其返流的部位与程度。结果：检出老年性退行性心瓣膜病变的患者285例,主要在60岁以上人群中发生,并随年龄增大发病率升高,男性多发于女性。老年性退行性心瓣膜病变以主动脉瓣及二尖瓣环发生率最高,主动脉瓣受累率明显高于二尖瓣,单纯性三尖瓣、肺动脉瓣少受累及,均与其它瓣膜受累并存。结论：彩色多普勒超声心动图可直接观察瓣膜厚度、回声强度及活动度,并可发现瓣环的钙化及返流程度,能明确诊断退行性心瓣膜病,对临床医师诊断及治疗有直接指导意义。     

心脏瓣膜钙化对血液透析患者冠状动脉钙化积分的预测价值

目的利用超声心动图研究终末期肾病血液透析患者心脏瓣膜钙化情况,探讨瓣膜钙化对冠状动脉钙化的预测价值。 方法对169例慢性肾病V期血液透析患者进行超声心动图检查评价心脏瓣膜钙化情况,并用多层螺旋CT扫描计算冠状动脉钙化积分。按照冠状动脉钙化积分11~100、101~400和≥400将患者分为3个危险等级;并根据心脏瓣膜钙化情况,将所有患者分为：无瓣膜钙化组、主动脉瓣钙化组、二尖瓣钙化组以及主动脉瓣、二尖瓣同时钙化组。Logistic回归分析瓣膜钙化与冠状动脉钙化积分危险分级之间的比值比。 结果受检的169例血液透析患者中88例（52.07%）患者存在瓣膜钙化。当患者出现主动脉瓣钙化时,冠状动脉钙化积分≥400的比值比为4.61,95%可信区间为1.22~17.4（P=0.02）,出现二尖瓣钙化时,冠脉钙化积分≥400的比值比为5.31,95%的可信区间为1.37~20.5（P=0.01）,当出现主动脉瓣、二尖瓣同时钙化时,冠状动脉钙化积分≥400的比值比为16.94,95%可信区间为5.16~55.58（P=0.001）。 结论血液透析患者心脏瓣膜钙化与冠状动脉钙化之间存在显著的相关性,超声心动图评价瓣膜钙化可以预测透析患者冠状动脉钙化的出现及危险分级。     

超声诊断老年性退行性瓣膜病的价值

目的探讨超声诊断老年性退行性心脏瓣膜病的价值.方法应用彩色多普勒超声诊断仪器,观察心脏瓣膜的形态、回声及活动度,并测量心腔房、室大小及瓣膜的厚度,室间隔、左室后壁厚度及左心功能.结果确诊病例30例,主动脉瓣、二尖瓣单纯钙化者8例(占26.7%);主动脉瓣、二尖瓣钙化致瓣口狭窄者22例(占73.3%);其中合并关闭不全者15例(占50%).结论老年性退行性心脏瓣膜病,是老年人常见的一种心脏病.早期症状多不明显,但随着年龄的增长及病变因素的增加,可导致心脏扩大、乳头肌功能不全、左心衰及心律失常等一系列临床症状.故早期诊断尤为重要.随着超声仪器的迅猛发展及诊断技术的不断完善,对此病的检出率有了很大的提高,超声诊断已成为诊断瓣膜病的重要工具.及早的发现、防治,为临床提供更可靠的诊断依据.     

超声心动图诊断老年性退行性心脏瓣膜病价值

目的:探讨超声心动图诊断老年性退行性心脏瓣膜病的价值.方法:回顾性分析1289例老年性退行性心脏瓣膜病患者的彩色多普勒超声声像图资料.结果:(1)检出老年性退行性心脏瓣膜病317例(28.8%),检出率随年龄增长增高(X2=101.46,P<0.01);(2)受累瓣膜中,主动脉单独受累191例(51.5%),二尖瓣单独受累96例(25.9%),主动脉瓣、二尖瓣同时受累84倒(22.6%);(3)113例有瓣膜功能障碍,其中主动脉瓣反流75例(66.4%),主动脉瓣狭窄11例(9.7%),主动脉瓣反流+主动脉瓣狭窄3例(2.7%);二尖瓣反流21例(18.6%),二尖瓣狭窄3例(3.1%).结论:超声心动图是诊断老年性退行性心脏瓣膜病主要手段.     

分析超声心动图在老年钙化性心脏瓣膜病中的应用

目的：分析超声心动图在老年钙化性心脏瓣膜病中的应用，为临床早期诊断提供影像学依据。方法：收集155例老年退行性心脏瓣膜病患者临床资料，将最终确诊为心脏瓣膜钙化的85例患者设为病例组，未出现心脏瓣膜钙化的70例患者作为对照组。两组患者均进行超声心动图检查，分析钙化性心脏瓣膜病超声心动图指标特征。结果：85例老年钙化性心脏瓣膜病患者中，钙化性心脏瓣膜病检出率为89.41%（76/85），其中主动脉瓣膜钙化患者42例，二尖瓣钙化患者21例，联合瓣膜钙化患者13例，无钙化患者9例；85例老年钙化性心脏瓣膜病，主动脉瓣与二尖瓣瓣膜反流共52例，占61.18%；主动脉瓣与二尖瓣瓣膜狭窄共24例，占28.24%。病例组左室舒张末期内径、左房内径均高于对照组，左室射血分数低于对照组，差异有统计学意义（P＜0.05）。结论：老年钙化性心脏瓣膜病患者超声心动图具有明显特征，经检查可发现存在左心室重构及左心功能减退的倾向，可作为早期诊断的影像学依据，且操作简单、安全无创。     

老年退行性心脏瓣膜病69例临床分析

老年退行性心脏瓣膜病（senilc degenrative heart valvular disease，SDHVD）是老年人（60岁以上）常见的瓣膜病变，又称为老年钙化性心瓣膜病或老年性心瓣膜病，本病大多数是在正常瓣膜基础上，随年龄增长，瓣膜产生老化、退行性变和钙质沉积所致，临床上以主动脉瓣和二尖瓣及其瓣环最常受累，可导致瓣膜狭窄和／或关闭不全，它是引起老年人心力衰竭、心律失常和猝死的重要原因之一。     

探讨超声心动图对老年钙化性心脏瓣膜病的诊断价值

目的:分析彩色多普勒超声心动图诊断老年钙化性心脏瓣膜病的临床价值。方法:以我院2014年1月-2017年1月期间收治的100例疑似老年钙化性心脏瓣膜病患者为例,所有患者均接受超声心动图检查。回顾性分析患者的检查结果,就其声像学特征和疾病情况展开分析。结果:经彩色多普勒超声心动图检查发现,100例患者中68例患者为单纯主动脉瓣受累,12例为单纯二尖瓣受累,20例两者同时受累。主动脉瓣钙化患者主动脉瓣增厚、回声增强,且存在瓣叶坚硬、活动受限的情况,多普勒可测出血流速度增快,瓣膜口反流,24例患者存在主动脉关闭不全和狭窄的情况。主动脉瓣环钙化处局限性斑块状反射增强≥主动脉根部回声反射。二尖瓣还钙化患者钙化情况从二尖瓣后叶及其基底部的心室面、瓣环、瓣根向瓣膜发展,瓣膜回声增强且均匀一致,2例患者存在二尖瓣关闭不全和狭窄的情况。主动脉瓣受累患者重度反流情况较二尖瓣受累显著较少,但主动脉瓣受累患者重度狭窄情况较多,两者比较差异有统计学意义(p0.05)。结论:超声心动图的操作方便、价格低廉,能够准确诊断出老年钙化性心脏瓣膜病情况,对于该病的诊断和治疗有重要意义。     

尿毒症病人心瓣膜钙化的超声心动图研究

本文应用超声心动图探测65例尿毒症病人的心脏瓣膜钙化的情况.结果二尖瓣钙化24例(37%),主动脉瓣钙化22例(33.5%),多为轻度钙化.其病因可能为透析前高血压和钙-磷代谢紊乱有关,积极控制高血压和平衡体内钙-磷代谢对预防心脏瓣膜钙化可能有一定作用.     

彩色多普勒超声在老年退行性心脏瓣膜病诊断中的应用价值

目的:探讨彩色多普勒超声在老年退行性心脏瓣膜病诊断中的应用价值。方法:本研究选取2017年11月-2019年11月我院收治的876例心脏病患者,均接受心脏彩色多普勒超声检查,对其临床资料进行回顾性分析。结果:本组876例心脏病患者共检出老年退行性心脏瓣膜病281例,总检出率为32.08%;男性检出率显著高于女性(P<0.05)。80岁以上年龄段疾病检出率最高,显著高于70~79岁及60~69岁人群(P<0.05)。281例患者中单纯主动脉瓣受累占比61.57%,单纯二尖瓣受累占比18.86%,主动脉瓣、二尖瓣同时受累19.57%。主动脉瓣狭窄49例,二尖瓣狭窄7例;瓣膜功能障碍87例,主动脉瓣反流占70.11%,二尖瓣反流18.39%。结论:心脏超声检查在老年退行性心脏瓣膜病诊断中具有重要应用价值,可作为疾病诊断检查的重要手段。     

老年脑梗塞患者心脏瓣膜二维超声及脉冲多普勒研究

脑梗塞是中老年人的常见病,为了探讨老年人脑梗塞患者与心脏瓣膜病变的关系。我们对75例老年脑梗塞病人进行了心脏瓣膜二维超声及脉冲多普勒检查,结果发现15例伴有心脏瓣膜病变,并以主动脉瓣膜多见,本文提出,心脏瓣膜病变是老年人脑梗塞不可忽视的一个重要原因,值得临床重视。     

老年瓣膜病患者瓣膜置换术术后死亡原因分析

目的 探讨分析老年瓣膜病患者瓣膜置换术术后死亡原因;方法 回顾性分析我院2007年2月-2013年2月收治的150例老年瓣膜病患者的临床资料,并分析对本组老年瓣膜病患者行瓣膜置换术术后发生死亡原因;结果 本组150例患者中死亡7例,占4.67%.临床经过统计分析可以得知,年龄、体外循环时间、阻断时间、术前心功能分级和心胸比与早期死亡发生有很大的关系;将这些具有显著差异因素进行多元Logistic分析结果表明,年龄、心功能、心胸比可能是造成老年心脏瓣膜置换术后早期死亡的独立危险因子（P＜0.01）.结论 老年瓣膜病患者瓣膜置换术术后死亡原因与年龄、心功能、心胸比以及患者自身疾病因素有很大的关系,临床早期治疗,及时改善患者心功能,术中谨慎操作,加强心肌保护,能够有效降低术后死亡率的发生.     

Specification of rheumatic fever contribution to formation of senile aortic stenosis

Calcinated aortic stenosis developing in the elderly is erroneously referred to atherosclerotic lesion of the valve or is thought to be rheumatic heart defect undetected previously. The atherosclerotic hypothesis is rejected by foreign investigated while a conception of postrheumatic damage is discussed in the light of immune inflammation found in the calcinated valve. Immunogenetic testing was used for investigation of correlations between senile aortic stenosis and rheumatic fever.     

Ultrasound evaluation of aortic valve anatomy in the fetus.

OBJECTIVE: To assess the feasibility of ultrasound identification of aortic valve anatomy in the fetus, with particular emphasis on the detection of bicuspid aortic valve. METHODS: This study was a prospective analysis of 21 fetuses with prenatally diagnosed congenital left heart obstructive lesions and 45 normal fetuses undergoing routine ultrasound evaluated at a tertiary referral center. These fetuses underwent detailed echocardiography, including the study of the aortic valve on a targeted short-axis view of the right ventricle. Necropsies or postnatal echocardiograms were available for confirmation of the diagnosis in all cases. RESULTS: Aortic cusps and commissures were satisfactorily visualized in 38/45 (84%) normal fetuses and in 18/21 (86%) fetuses with congenital heart disease. The aortic valve was correctly defined as bicuspid in one normal fetus and in six fetuses with congenital heart disease. In two fetuses with a positive family history, the bicuspid aortic valve was isolated. There was one incorrect diagnosis (a unicuspid unicommissural valve diagnosed prenatally as a bicuspid aortic valve in a fetus with severe aortic stenosis) and one false-positive diagnosis in a fetus diagnosed with a coarctation and a bicuspid aortic valve late in the third trimester of pregnancy and in which both anomalies were not confirmed at neonatal echocardiography. CONCLUSIONS: This study demonstrated that aortic valve anatomy can be satisfactorily assessed in fetuses with and without left heart obstructive lesions. We believe that a detailed search for a bicuspid aortic valve should be attempted in all patients referred for a positive family history of congenital heart disease, in general, and of left ventricle outflow tract obstruction or bicuspid aortic valve, in particular. In fact, the presence of an asymptomatic bicuspid aortic valve has been demonstrated to represent an important factor predisposing to the development of bacterial endocarditis and dissecting aortic aneurysm late in adult life. Therefore, an early detection of such an anomaly may contribute to ensure a longer symptom-free lifespan of individuals with the most common cardiac anomaly at birth.     

经皮二尖瓣球囊成形术8例分析

应用Inone法经皮二尖瓣球囊成形术治疗风湿性心脏病单纯二尖瓣狭窄3例，二尖瓣狭窄伴轻度二尖瓣返流3例，二失瓣狭窄伴主动脉瓣关闭不全2例，均获成功。手术后二尖瓣面积、肺动脉压，左房平均压均较手术前明显改善，部分心功能改善。术前病例选择，术中房问隔穿刺及球襄直径的选择，对增加成功率，预防并发症极为重要。     

Sutureless aortic valves over the last 45 years

Degenerative and calcified aortic stenosis is the most common form of adult valvular heart disease, and surgical aortic valve replacement (AVR) with the use of extracorporeal circulation (ECC) is currently the method of choice which can be performed at low risk. However, older patients with multiple pre-existing ‘high-risk’ comorbid conditions may benefit from reduced ECC time and thus reduced myocardial ischemia by the use of minimally invasive or interventional aortic valve implantation. Therefore, a sutureless concept of aortic valve implantation came up in the early sixties. However, this innovative concept of sutureless heart valve implantation was abandoned again due to several disadvantages. To date, there is a growing need for fast sutureless implantation of valve prostheses due to an increase in comorbidities. New challenging fields in aortic valve surgery have been recently rediscovered followed by an improvement of the sutureless valve implantation technique. Therefore, we reviewed the current and historical literature describing valve design and materials, as well as clinical data based on valve-related complications or morbidity/mortality.     

Aortic stenosis: diagnosis and treatment

Aortic stenosis is the most important cardiac valve disease in developed countries, affecting 3 percent of persons older than 65 years. Although the survival rate in asymptomatic patients with aortic stenosis is comparable to that in age- and sex-matched control patients, the average overall survival rate in symptomatic persons without aortic valve replacement is two to three years. During the asymptomatic latent period, left ventricular hypertrophy and atrial augmentation of preload compensate for the increase in afterload caused by aortic stenosis. As the disease worsens, these compensatory mechanisms become inadequate, leading to symptoms of heart failure, angina, or syncope. Aortic valve replacement should be recommended in most patients with any of these symptoms accompanied by evidence of significant aortic stenosis on echocardiography. Watchful waiting is recommended for most asymptomatic patients, including those with hemodynamically significant aortic stenosis. Patients should be educated about symptoms and the importance of promptly reporting them to their physicians. Serial Doppler echocardiography is recommended annually for severe aortic stenosis, every one or two years for moderate disease, and every three to five years for mild disease. Cardiology referral is recommended for all patients with symptomatic aortic stenosis, those with severe aortic stenosis without apparent symptoms, and those with left ventricular dysfunction. Many patients with asymptomatic aortic stenosis have concurrent cardiac conditions, such as hypertension, atrial fibrillation, and coronary artery disease, which should also be carefully managed.     

Bicuspid aortic valve: clinical approach and scientific review of a common clinical entity

Bicuspid aortic valve (BAV) disease is becoming increasingly respected by clinicians. This enhanced appreciation is based on recognition of how common and virulent this disease really is. This disease is now known to be the most common congenital lesion affecting the human heart (with potential competition in frequency posed by mitral valve prolapse). It is estimated that the BAV lesion alone accounts for more morbidity and mortality than all the other congenital cardiac lesions combined. Many authorities feel that this disease is so virulent that every individual with a BAV will, given enough time, develop aortic stenosis, aortic insufficiency or aortic aneurysm/dissection related to the bicuspid valve disease. This review looks in detail at clinical issues related to BAV disease, including genetics, pathophysiology, diagnosis, management and surgical decision making. The picture emerging from basic and clinical studies is of a defect in collagen metabolism affecting not only the aortic valve, but also the wall of the aorta itself. Timely intervention for bicuspid-related aortic valve disease or aneurysm can preserve both duration of life and quality of life in affected individuals.