老年退行性心脏瓣膜病超声及心电图特点

目的：观察老年性退行性心脏瓣膜病超声及心电图特点。方法：46例经彩色多普勒超声心动图确诊为老年性退行性心脏瓣膜病患作为分析对象（合并高血压及高血压心脏病20例，冠心病10例，心肌病6例，陈旧性心肌梗死2例），观察病人超声心动图心脏结构、心功能及心电图变化，心脏瓣膜钙化以主动脉瓣钙化率最高（73．9％），其次为二尖瓣钙化（43．5％）。结果；有12例（26．1％） 发生心脏结构的改变，26例（56．5％）发生心律失常，31例（67．3％）呈心功能减退。结论：通过彩超及心电图的检查，可提高老年退行性心脏瓣膜病的检出率，对临床的诊断及治疗具有一定的指导意义。     

老年退行性瓣膜病超声心动图分析

本文回顾分析了 2 12 0例 6 0岁以上人群的超声心动图资料 ,进一步探讨老年退行性瓣膜病的发病情况与超声心动图特点。1　资料与方法1.1　研究对象　 1992年 3月至 1999年 5月到我院进行超声心动图检查的 6 0岁以上老年人 2 12 0例 ,其中男 130 3例 ,女 817例 ,年龄 6 0～ 98岁 ,既往无瓣膜病史 ,所有受检者分为 4组。其中符合冠心病诊者 30 6例 ,高血压病 178例 ,糖尿病 2 1例 ,慢支 2 0例。1.2　研究方法　超声心动图检查 :美国ＨＰ 770 2 0ＡＣ及ＨＰ 5 5 0 0型彩色多普勒超声诊断仪 ,探头频率 2 5ＭＨｚ及 2～ 4ＭＨｚ。取左侧卧位 ,于…     

老年退行性瓣膜病的临床表现及诊断

在老年人中,退行性病变引起的心瓣膜病是该年龄阶段比较具有临床意义的心瓣膜疾病。随着年龄的增加,心瓣膜结缔组织发生退行性变、纤维化和钙化,从而导致瓣膜及其支架的功能异常,引起瓣膜狭窄和(或)关闭不全,这是一个衰老过程,称为老年退行性瓣膜病,亦可称为老年心脏钙化综合征,其真正病因尚不清楚。随着人类寿命的延长,老年退行性瓣膜病发生率日益增加,是老年人心力衰竭、心律失常、晕厥和猝死的重原因之一。因此需提高临床医师对本病的认识,及时诊断,因人而异地采取治疗措施,从而延长寿命,改善生活质量。1　临床表现　　老年退行性瓣膜病…     

老年退行性瓣膜病的治疗

因老年退行性瓣膜病的确切病因尚未明,治疗均非病因性的,也尚无有效的方法阻止本病的发展。本病早期可在相当长的时间内无症状,也无需治疗,应动态观察病情。待瓣膜损害到影响血流动力学后,由代偿期进入代偿失调期,或根据病程中出现的症状和并发症给予相应处理。1　重视对并存基础病有关症状的治疗　　与老年退行性瓣膜病有关、并存的主要疾病为高血压、糖尿病及高脂血症,要给相应治疗。及时治疗慢支肺气肿及肺功能不全的疾病以改善氧供。应用药物要尽量兼顾全身情况,注意老年人常伴存的多脏器病变,尽量避免对肝肾功能的不良副作用。症状最多…     

106例老年人退行性心脏瓣膜病的超声诊断分析

老年人退行性心脏瓣膜钙化导致血流动力学障碍 ,加重心功能损害 ,成为老年人充血性心力衰竭、心绞痛、心律失常、昏厥甚至猝死的重要原因之一。彩色超声 Doppler可提高诊断本病的敏感性和特异性。现将我院近年来受检患者中10 6例老年人退行性心脏瓣膜钙化患者的资料进行分析研究。资料及方法1.1　观察对象本组 10 6例 ,男 84例 ,女 2 2例 ,年龄均 >5 5岁 ,其中 >60岁者占 82 .9%。根据病史、临床及辅助检查 ,均除外其他先天性或获得性瓣膜病变者。1.2　方法应用美国 ATL超 9彩色多普勒超声诊断仪 ,探头频率3 .0 MHz。取胸骨旁左心室长轴 …     

老年退行性心脏瓣膜病超声心动图的临床应用

目的 探讨超声心动图在老年退行性瓣膜病中的应用价值,评价超声心动图对老年退行性心脏瓣膜病的检查价值.方法 回顾分析2010-2011年600例60岁以上老年人的彩色多谱勒超声心动图及临床资料.通过超声观察心脏瓣膜的形态、回声、厚度、活动度、室间隔、左室后壁厚度、心腔大小及左心功能.结果 检出退行性钙化瓣病350例,总患病率58.3％,其中男性检出150例(42.9％),女性检出200例(57.1％).随着年龄的增长,男、女的检出率变化差异无统计学意义(P＞0.05),但检出率逐渐增高,差异有统计学意义(P＜0.01).结论 随着年龄的增长,老年退行性瓣膜病呈递增趋势,超声心动图可及早发现,为临床早期治疗提供诊断依据.     

老年退行性心脏瓣膜病的临床与超声研究

老年退行性心脏瓣膜病又称为老年钙化性心脏瓣膜病或老年性心脏瓣膜病。随着年龄的增长、心脏瓣膜结缔组织发生退行性变，纤维化，钙化，从而使瓣膜和其支架功能异常。现将我院1993年1月至1595年12月三年间经心脏彩色多普勒检出本病的368例瓣膜钙化情况与临床作一分析。     

老年退行性心脏瓣膜病患者超声心动图显像特征及相关危险因素

目的探讨老年退行性心脏瓣膜病患者超声心动图显像特征及相关危险因素。方法回顾性分析2016年2月至2017年8月于滨州市中医医院接受心超声心动图检查的500例老年体检者的临床资料。根据超声心动图结果,老年退行性心脏瓣膜病患者120例(65～70岁26例、71～80岁50例、81～90岁44例),非退行性心脏瓣膜病体检者380例。分析老年退行性心脏瓣膜病患者的超声心动图显像特征及其与临床资料的关系,并应用多因素Logistic回归分析分析老年退行性心脏瓣膜病的危险因素。结果 65～70岁组老年退行性心脏瓣膜病的发病率明显低于71～80岁组与81～90岁组(P<0.05)。81～90岁组老年退行性心脏瓣膜病患者单纯主动脉瓣发病人数占比明显高于65～70岁组、71～80岁组,而主动脉瓣+二尖瓣发病人数占比明显低于65～70岁组、71～80岁组(P<0.05)。单因素分析结果显示,老年退行性心脏瓣膜病的发生与吸烟、酗酒、冠心病、糖尿病、高血压、脑卒中及高脂血症有关(均P<0.05)。多因素Logistic回归分析显示:年龄、吸烟、酗酒、患有高血压、脑卒中及高脂血症均为影响老年退行性心脏瓣膜病发生的独立危险因素(P<0.05)。结论老年退行性心脏瓣膜病多见主动脉瓣病变,且年龄,吸烟,酗酒,冠心病,糖尿病,高血压,脑卒中及高脂血症均可能导致老年退行性心脏瓣膜病的发生,值得临床重点关注。     

老年人退行性心脏瓣膜病的研究近况

近年来随着心血管检测技术的不断提高和经皮穿刺腔内球囊瓣膜成形术的广泛应用,使老年人退行性心脏瓣膜病的诊断和治疗取得重大进展。本文着重介绍该病的发病率、病理生理以及诊断和治疗的研究概况。     

老年退行性心脏瓣膜病与心律失常的临床分析

目的探讨和进一步提高对老年人心律失常发生原因的认识。方法分析１０７例经彩色多普勒超声心动仪检查而确诊为老年退行性心脏瓣膜病患者心律失常发生情况,全部患者首先根据病史、系统体格检查、心电图、２４ｈ动态心电图、超声心动图、实验室检查资料完全排除了风湿性心脏瓣膜病、先天性心脏瓣膜病、感染性心内膜炎及其他继发性心脏瓣膜病。结果其心律失常的发生率为７６．６％,其中室上性心律失常占５２．４％,室性心律失常占１３．４％,房性心律失常并室性心律失常占９．８％,各种类型传导阻滞占２４．３％。结论老年人心律失常的发生与心肌的退行性变以及病变心肌的扩张、钙化涉及传导系统有关。     

老年钙化性心瓣膜病的病理学研究

老年钙化性心瓣膜病是老年人最常见的瓣膜疾病,1904年Ｍｏｎｃｈｋｅｂｅｒｙ首先发现人在自然衰老的过程中会出现退行性变,导致钙化性主动脉瓣狭窄,1910年Ｄｅｗｉｔｓｋｙ首次描述了二尖瓣环钙化。随着人类寿命的延长,本病的发病率随年龄增长而升高,Ｌｉｎｄｒｏｏｓ等在75～76岁、80～81岁、85～86岁3个年龄组随机抽取501人进行超声心动图检查,发现不同程度主动脉瓣钙化发生率是53%,临床钙化性主动脉狭窄的发病率是29%。Ｓｔｅｗａｒｔ等对≥65岁老年人5102例进行心血管健康研究显示,主动脉硬化发生率是26%,主动脉狭窄为2%;在≥75岁的人…     

Screening cardiac ultrasonographic examination in patients with suspected cardiac disease in the emergency department

BACKGROUND/OBJECTIVE: Our purpose was to evaluate the utility of a brief screening cardiac ultrasonographic (SCU) examination. We prospectively compared the SCU with conventional clinical evaluation in 124 emergency department (ED) patients with suspected cardiac disease. Furthermore, we assessed the impact and quality of SCU examinations as obtained by briefly trained ED personnel (EP). METHODS: Patients underwent clinical evaluation by an ED physician and SCU examination by a sonographer or cardiologist. Patient disposition, hospital stay length, and the number of full echo examinations were compared with the presence of significant findings on SCU. In patients who received a full echocardiogram during hospitalization, results of the initial clinical examination were compared with results of the SCU examination in the diagnosis of significant findings. A similar analysis, but with quality assessment, was performed on only those SCU examinations acquired by 4 EP. RESULTS: Of the 124 patients enrolled in the main study, 40 of 124 (32%) had significant findings on SCU. Of patients with abnormal SCUs versus normal SCUs, 16 of 40 (40%) versus 18 of 84 (21%) had hospital stay lengths >2 days (P < or =.05). Using the 36 inpatient full echo studies obtained for standard indications during hospitalization as a gold standard, initial clinical examination identified only 7 of 30 (23%) significant findings and had 16 false-positive diagnoses, whereas SCU identified 22 of 30 (73%) with 8 false positives. Although similar study results occurred with interpretation of 68 SCUs obtained by EP, quality was achieved in only 55% ED personnel versus 97% of sonographer-obtained SCUs (P <.05). CONCLUSIONS: An SCU examination detects significant findings misdiagnosed on initial clinical evaluation in the ED and provides prognostic data regarding length of hospital stay.     

复发性心脏瓣膜病再次外科治疗效果及其相关因素

目的:回顾性分析对二尖瓣闭式扩张术、瓣膜成形术、瓣周漏、人工机械瓣功能障碍、生物瓣衰坏等原因引起的复发性瓣膜病变进行再次手术的效果和相关因素。方法: 复发性瓣膜病患者331（男143,女188）例,年龄12～73(46±12)岁,两次手术间隔时间2月～25(17±8)年。其中二尖瓣闭式扩张术后再狭窄143例,二尖瓣或主动脉瓣成形术后瓣膜病变复发53例,生物瓣衰坏32例,瓣周漏26例,换瓣术后其它瓣膜病21例,人工瓣膜替换或瓣膜成形术后心内膜炎17例, Ebstein畸形矫治术后三尖瓣关闭不全15例,人工瓣膜机械功能故障9例,室间隔缺损修补术并行瓣膜成形术后心内膜炎7例,完全或部分性心内膜垫缺损和矫正性大动脉转位术后二尖瓣或三尖瓣关闭不全6 例,二尖瓣球囊扩张术2例。再次手术方式为二尖瓣替换术,主动脉瓣替换术,二尖瓣和主动脉瓣替换术,三尖瓣替换术,瓣周漏修补术及三尖瓣成形术等。结果: 全组共死亡27例,占8.2％,早期主要死亡原因为低心排出量综合征、室性心律失常、多脏器功能衰竭、左心室破裂、感染性心内膜炎、肾功能衰竭。随访259例,随访期6月～21（10±7）年,心功能恢复至Ⅰ～Ⅱ级189例。复发性心脏瓣膜病再次手术的危险因素包括术前心功能差、重要脏器功能不全、急诊手术、主动脉阻断时间和体外循环时间长等。结论: 针对再手术相关的危险因素进行积极防治,适时而妥善的外科手术和围手术期处理仍可获良好效果。     

白塞病心脏瓣膜损害的超声表现

目的　加深对白塞病 (BD)心脏瓣膜损害的认识。方法　分析于 1990 - 11～ 2 0 0 3- 0 6间广东省人民医院收治的 5 0例BD中 13例心脏瓣膜损害患者的超声结果并与手术对照。结果　 (1)BD心脏瓣膜损害并不少见 ,超声发现 2 6 % (13/ 5 0 )BD患者有心脏瓣膜损害。 (2 )BD心脏瓣膜损害的形态学改变主要为脱垂、穿孔及撕裂 ;功能改变主要为瓣膜关闭不全。 (3) 5例患者行人工瓣膜置换术 ,4例需要再次换瓣。结论　超声心动图检查为BD的心脏瓣膜损害提供了形态及功能方面的重要信息。     

Single-cell RNA sequencing reveals the diversity and biology of valve cells in cardiac valve disease

From highly aligned extracellular fibrils to the cells, a multilevel ordered hierarchy in valve leaflets is crucial for their biological function. Cardiac valve pathology most frequently involves a disruption in normal structure-function correlations through abnormal and complex interaction of cells, extracellular matrix, and their environment. At present, effective treatment for valve disease is limited and frequently ends with surgical repair or replacement with a mechanical or artificial biological cardiac valve, which comes with insuperable complications for many high-risk patients including aged and pediatric populations. Therefore, there is a critical need to fully appreciate the pathobiology of valve disease in order to develop better, alternative therapies. To date, the majority of studies have focused on delineating valve disease mechanisms at the cellular level. However, the cellular heterogeneity and function is still unclear. In this review, we summarize the body of work on valve cells, with a particular focus on the discoveries about valve cells heterogeneity and functions using single-cell RNA sequencing. We conclude by discussing state-of-the-art strategies for deciphering heterogeneity of these complex cell types, and argue this knowledge could translate into the improved personalized treatment of cardiac valve disease.     

The significance of cardiac arrhythmias in the aged

Twenty-four-hour ambulatory electrocardiography was performed in 25 young and 29 active elderly subjects. Sinus bradycardia and sinus arrhythmia were common in the young but uncommon in the elderly. Ventricular and supraventricular premature beats and brief runs of supraventricular tachycardia were common in the elderly but uncommon in the young. Complex ventricular arrhythmias only occurred in the elderly but brief episodes of nocturnal Wenckebach AV block were quite common in young and old alike. No significant difference in arrhythmia frequency was found between elderly subjects with heart disease and those without heart disease or between elderly subjects without symptoms and those with non-episodic symptoms such as dizziness. None of the arrhythmias in the young or elderly subjects was associated with symptoms. In follow-up at 30 months, only one elderly subject was deceased (from pneumonia) and none had suffered a stroke or heart attack. It is concluded that transient cardiac arrhythmias are commoner in the elderly than in the young. However, their long-term significance remains unknown, but it is likely that they are relatively benign.     

老年胃食管反流病患者临床特征分析

Objective To analyze clinical characteristics of gastroesophageal reflux disease(GERD) in aged patients for improvement of diagnosis and treatemcnt. Methods The reflux disease questionnaire was performed in patients diagnosed as GERD based on Montreal definition and classification as well as Rome Ⅲ criteria.All patients were divided into elderly group (≥65 years) and control group(＜65 years). The incidence of hita[ hernia (HH), the frequencies of esophagitis (based on Los Angeles classification), clinical features, and quality of life were compared between two groups. Results There was no difference between two groups in male/female ratio and morbidity of HH(P＞0.05). In comparison with control group, the frequency of esophagitis graded as LC or LD increased and extra-esophageal symptoms were higher in elderly group (P＜ 0.05), but the lower typical symptoms (heartburn and regurgitation) were seen in the elderly group(P＜0.05). The scores of role physical, bodily pain and role emotional were higher in elderly group than those in control group (P＜0.05). There was no significant differences between two groups in physical function, vitality,social functioning, mental health, and general health. Conclusion The elderly GERD patients often have lower score of typical reflux symptoms (heartburn and regurgitation) and high incidence of severer esophagitis, but their quality of life is not significantly influenced.