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- 1. 贵阳医学院内科教研室心血管科贵阳医学院内科教研室心血管科 循环系统疾循环系统疾 病病 心脏瓣膜病心脏瓣膜病 Valvular heartValvular heart diseasedisease
- 9. 贵阳医学院内科教研室心血管科 概 述概 述 风湿性心脏病风湿性心脏病 ((rheumaticrheumatic heart diseaseheart disease )) ，简称，简称风心风心 病病 风湿性心脏炎遗留以心脏风湿性心脏炎遗留以心脏瓣膜瓣膜 损害为主损害为主的心脏病的心脏病 最常见最常见的心脏瓣膜病的心脏瓣膜病 主要见于＜主要见于＜ 4040 岁人群岁人群
- 13. 贵阳医学院内科教研室心血管科
- 18. 贵阳医学院内科教研室心血管科 ㈢临床表现⒈症状㈢临床表现⒈症状 ⑴⑴ 呼吸困难呼吸困难 ①① 进行性加重劳力性呼吸困难进行性加重劳力性呼吸困难 ②② 阵发性夜间呼吸困难阵发性夜间呼吸困难 ③③ 端坐呼吸端坐呼吸 ④④ 急性心源性肺水肿急性心源性肺水肿
- 19. 贵阳医学院内科教研室心血管科 ⑵⑵ 咯血咯血 ①① 支气管静脉破裂支气管静脉破裂 ②② 支气管粘膜或肺泡毛细血支气管粘膜或肺泡毛细血 管破裂管破裂 ③③ 急性肺水肿急性肺水肿 ④④ 肺梗死肺梗死
- 24. 贵阳医学院内科教研室心血管科
- 25. 贵阳医学院内科教研室心血管科
- 26. 贵阳医学院内科教研室心血管科
- 27. 贵阳医学院内科教研室心血管科 ⑵⑵ 肺动脉高压和右心肺动脉高压和右心 室扩大的体征室扩大的体征 PP22 亢进、分裂亢进、分裂 相对性肺动脉瓣关闭不相对性肺动脉瓣关闭不 全全 ((Graham SteellGraham Steell 杂杂 音音 ))
- 28. 贵阳医学院内科教研室心血管科 ㈣实验室及器械检查㈣实验室及器械检查 ⒈⒈ 胸部胸部 XX 线检查线检查
- 29. 贵阳医学院内科教研室心血管科 ⑴⑴ 左心房增大左心房增大 左心缘心腰部消失或膨出左心缘心腰部消失或膨出 右心缘双心房影右心缘双心房影 LAOLAO 左主支气管上抬左主支气管上抬 RAORAO 食管下段后移食管下段后移
- 30. 贵阳医学院内科教研室心血管科 ⑵⑵ 其他胸部其他胸部 XX 线征线征 象象 右心室增大、肺动脉干扩右心室增大、肺动脉干扩 张、主动脉结缩小张、主动脉结缩小 梨形心梨形心 (( 二尖瓣型心脏二尖瓣型心脏 )) 肺淤血、间质性肺水肿、肺淤血、间质性肺水肿、 含铁血黄素沉着含铁血黄素沉着
- 31. 贵阳医学院内科教研室心血管科
- 32. 贵阳医学院内科教研室心血管科
- 33. 贵阳医学院内科教研室心血管科 ⒉⒉ 心电图心电图 二尖瓣型二尖瓣型 PP 波波 PP 波宽度≥波宽度≥ 0.12s0.12s 、切、切 迹、迹、 VV1ptf1ptf ≥0.04ms≥0.04ms 右心室肥大右心室肥大 心房颤动心房颤动
- 34. 贵阳医学院内科教研室心血管科 ⒊⒊ 超声心动图超声心动图 ⑴⑴MM 型型 EFEF 斜率降低、斜率降低、 AA 峰消失峰消失 呈城墙垛样改变呈城墙垛样改变 后叶前向移动后叶前向移动 瓣叶增厚瓣叶增厚
- 36. 贵阳医学院内科教研室心血管科
- 37. 贵阳医学院内科教研室心血管科 二尖瓣瓣口面积二尖瓣瓣口面积 正常正常 4.0-6.0cm4.0-6.0cm22 轻度轻度 2.0-1.6cm2.0-1.6cm22 中度中度 1.5-1.0cm1.5-1.0cm22 重度＜重度＜ 1.0cm1.0cm22
- 38. 贵阳医学院内科教研室心血管科
- 39. 贵阳医学院内科教研室心血管科 ㈤诊断与鉴别诊断㈤诊断与鉴别诊断 ⒈⒈ 诊断诊断 依据依据心尖部舒张期心尖部舒张期隆隆样隆隆样杂音杂音 ，伴，伴 XX 线或心电图提示线或心电图提示左心左心 房增大房增大，一般可诊断，一般可诊断 UCGUCG 可确诊可确诊
- 40. 贵阳医学院内科教研室心血管科 ⒉⒉ 鉴别诊断鉴别诊断 ⑴⑴ 二尖瓣口血流量增加二尖瓣口血流量增加 严重二尖瓣返流严重二尖瓣返流 大量左向右分流先心病大量左向右分流先心病 高动力循环状态高动力循环状态
- 41. 贵阳医学院内科教研室心血管科 ⒉⒉ 鉴别诊断鉴别诊断 ⑵⑵Austin-FlintAustin-Flint 杂音杂音 见于严重主动脉瓣关闭不见于严重主动脉瓣关闭不 全全 ⑶⑶ 左心房粘液瘤左心房粘液瘤
- 44. 贵阳医学院内科教研室心血管科
- 45. 贵阳医学院内科教研室心血管科
- 46. 贵阳医学院内科教研室心血管科 ⒈⒈ 慢性慢性 ⑵⑵ 二尖瓣脱垂二尖瓣脱垂 ⑶⑶ 感染性心内膜炎感染性心内膜炎 ⑷⑷ 左心室显著扩大左心室显著扩大 ⑸⑸ 二尖瓣环退行性变及钙化二尖瓣环退行性变及钙化 ⑹⑹ 腱索病变腱索病变
- 47. 贵阳医学院内科教研室心血管科
- 48. 贵阳医学院内科教研室心血管科
- 49. 贵阳医学院内科教研室心血管科
- 51. 贵阳医学院内科教研室心血管科 ⒉⒉ 急性急性 ⑴⑴ 急性心肌梗死急性心肌梗死 乳头肌功能失调或断裂乳头肌功能失调或断裂 ⑵⑵ 感染性心内膜炎感染性心内膜炎 ⑶⑶ 腱索断裂腱索断裂 ⑷⑷ 创伤创伤 ⑸⑸ 人工心脏瓣膜损坏人工心脏瓣膜损坏
- 52. 贵阳医学院内科教研室心血管科
- 56. 贵阳医学院内科教研室心血管科 ⒉⒉ 体征体征 ⑴⑴ 心尖部心尖部全全收缩期收缩期粗糙吹粗糙吹 风样高调一贯型杂音风样高调一贯型杂音 强度≥强度≥ 3/63/6 级级 向左侧腋下及背部传导（前向左侧腋下及背部传导（前 叶）或向胸骨左缘及心底部叶）或向胸骨左缘及心底部 传导（后叶）传导（后叶）
- 57. 贵阳医学院内科教研室心血管科 ⒉⒉ 体征体征 ⑵⑵SS11 减弱，可闻减弱，可闻 SS33 ，， PP22 亢亢 进分裂进分裂 ⑶⑶ 心尖搏动向左下移位，心心尖搏动向左下移位，心 界向左下扩大，可有抬举界向左下扩大，可有抬举 性心尖搏动性心尖搏动
- 58. 贵阳医学院内科教研室心血管科 ㈣实验室及器械检查㈣实验室及器械检查 ⒈⒈ 胸部胸部 XX 线检查线检查 左心房与左心室扩大左心房与左心室扩大 肺淤血肺淤血 间质性肺水肿间质性肺水肿 肺泡性肺水肿肺泡性肺水肿
- 59. 贵阳医学院内科教研室心血管科
- 60. 贵阳医学院内科教研室心血管科
- 62. 贵阳医学院内科教研室心血管科 ⒊⒊ 超声心动图超声心动图 ⑴⑴MM 型型 左心房后壁活动曲线收缩期出左心房后壁活动曲线收缩期出 现明显现明显 CC 凹凹 二尖瓣前瓣二尖瓣前瓣 EFEF 斜率增速斜率增速
- 64. 贵阳医学院内科教研室心血管科 ⒊⒊ 超声心动图超声心动图 ⑶⑶ 多普勒多普勒 二尖瓣左心房侧和左心房内探二尖瓣左心房侧和左心房内探 察到收缩期反流束察到收缩期反流束 最大反流束面积＜最大反流束面积＜ 4cm4cm22 轻度轻度 ，， 4-8cm4-8cm22 中度，＞中度，＞ 8cm8cm22 重重 度度
- 65. 贵阳医学院内科教研室心血管科
- 67. 贵阳医学院内科教研室心血管科 ⒉⒉ 鉴别诊断鉴别诊断 ⑴⑴ 三尖瓣关闭不全三尖瓣关闭不全 ⑵⑵ 室间隔缺损室间隔缺损 ⑶⑶ 主动脉或肺动脉瓣狭窄主动脉或肺动脉瓣狭窄 ⑷⑷ 心尖部生理性杂音心尖部生理性杂音
- 69. 贵阳医学院内科教研室心血管科 ㈠病因㈠病因 ⒈⒈ 慢性慢性 ⑴⑴ 主动脉瓣疾病主动脉瓣疾病 ①① 风心病风心病 男性多见男性多见 常合并狭窄及二尖瓣病变常合并狭窄及二尖瓣病变 单纯性少见单纯性少见
- 70. 贵阳医学院内科教研室心血管科
- 71. 贵阳医学院内科教研室心血管科 ⑴⑴ 主动脉瓣疾病主动脉瓣疾病 ②② 感染性心内膜炎感染性心内膜炎 ③③ 先天性畸形 二叶主动脉先天性畸形 二叶主动脉 瓣瓣 ④④ 主动脉瓣粘液样变性主动脉瓣粘液样变性 ⑤⑤ 强直性脊柱炎强直性脊柱炎
- 72. 贵阳医学院内科教研室心血管科 ⑵⑵ 主动脉根部扩张主动脉根部扩张 ①① 梅毒性主动脉炎梅毒性主动脉炎 ②②MarfanMarfan 综合征综合征 ③③ 强直性脊柱炎强直性脊柱炎 ④④ 特发性升主动脉扩张特发性升主动脉扩张 ⑤⑤ 严重高血压和严重高血压和 // 或动或动 脉粥样硬化脉粥样硬化
- 73. 贵阳医学院内科教研室心血管科
- 74. 贵阳医学院内科教研室心血管科 ⒉⒉ 急性急性 ①① 感染性心内膜炎感染性心内膜炎 ②② 创伤创伤 ③③ 主动脉夹层主动脉夹层 ④④ 人工心脏瓣膜破裂人工心脏瓣膜破裂
- 78. 贵阳医学院内科教研室心血管科 ⒉⒉ 体征体征 ⑴⑴ 主动脉瓣听诊区主动脉瓣听诊区或或主动脉主动脉 瓣第二听诊区瓣第二听诊区高调叹气样高调叹气样 递减型递减型舒张舒张早期杂音，坐早期杂音，坐 位身体前倾深呼气末较清位身体前倾深呼气末较清 楚楚 ⑵⑵Austin-FlintAustin-Flint 杂音杂音 相对性二尖瓣狭窄相对性二尖瓣狭窄
- 79. 贵阳医学院内科教研室心血管科 ⒉⒉ 体征体征 ⑶⑶SS11 减弱，减弱， AA22 减弱或缺如减弱或缺如 ，可闻，可闻 SS33 ⑷⑷ 心尖搏动向左下移位，心尖搏动向左下移位， 心界向左下扩大，可有抬心界向左下扩大，可有抬 举性心尖搏动举性心尖搏动
- 80. 贵阳医学院内科教研室心血管科 ⑸⑸ 周围血管体征周围血管体征 毛细血管搏动毛细血管搏动 水冲脉水冲脉 动脉枪击音动脉枪击音 ((TraubeTraube 征征 )) 动脉双期血管杂音动脉双期血管杂音 ((DuroziezDuroziez 征征 )) 点头状运动点头状运动 ((De MussetDe Musset
- 81. 贵阳医学院内科教研室心血管科 ㈣实验室及器械检查㈣实验室及器械检查 ⒈⒈ 胸部胸部 XX 线检查线检查 左心室增大左心室增大 升主动脉扩张升主动脉扩张 靴形心（主动脉型心脏）靴形心（主动脉型心脏） 肺淤血 心源性肺水肿肺淤血 心源性肺水肿
- 82. 贵阳医学院内科教研室心血管科
- 88. 贵阳医学院内科教研室心血管科 ⒉⒉ 鉴别诊断鉴别诊断 Graham SteellGraham Steell 杂音与杂音与 二尖瓣狭窄二尖瓣狭窄
- 92. 贵阳医学院内科教研室心血管科
- 93. 贵阳医学院内科教研室心血管科
- 97. 贵阳医学院内科教研室心血管科 ⒉⒉ 体征体征 ⑴⑴ 主动脉瓣听诊区主动脉瓣听诊区递增递增 -- 递减递减 型粗糙喷射性吹风样型粗糙喷射性吹风样 收缩期收缩期 杂音杂音 向颈部动脉、胸骨左下缘及心尖向颈部动脉、胸骨左下缘及心尖 部传导部传导 常伴震颤常伴震颤
- 98. 贵阳医学院内科教研室心血管科 ⒉⒉ 体征体征 ⑵⑵AA22 减弱或消失，可闻减弱或消失，可闻 SS44 ⑶⑶ 抬举性心尖搏动，心界不抬举性心尖搏动，心界不 大或稍大大或稍大
- 99. 贵阳医学院内科教研室心血管科 ㈣实验室及器械检查㈣实验室及器械检查 ⒈⒈ 胸部胸部 XX 线检查线检查 心影正常或轻度增大心影正常或轻度增大 升主动脉根部扩张升主动脉根部扩张 主动脉瓣钙化主动脉瓣钙化 肺淤血、心源性肺水肿肺淤血、心源性肺水肿
- 100. 贵阳医学院内科教研室心血管科
- 104. 贵阳医学院内科教研室心血管科 ⒉⒉ 鉴别诊断鉴别诊断 ⑴⑴ 肺动脉瓣狭窄肺动脉瓣狭窄 ⑵⑵ 梗阻性肥厚型心肌病梗阻性肥厚型心肌病 ⑶⑶ 室间隔缺损室间隔缺损
- 106. 贵阳医学院内科教研室心血管科 ㈠病因㈠病因 ⒈⒈ 一种病因损害多个瓣膜一种病因损害多个瓣膜 ⒉⒉ 一个瓣膜损害容量或压力一个瓣膜损害容量或压力 负荷过重，继发近端瓣膜负荷过重，继发近端瓣膜 功能损害功能损害 ⒊⒊ 不同病因损害不同瓣膜不同病因损害不同瓣膜
- 107. 贵阳医学院内科教研室心血管科
- 108. 贵阳医学院内科教研室心血管科 ㈡病理生理㈡病理生理 ⒈⒈ 严重损害掩盖轻度损害严重损害掩盖轻度损害 ⒉⒉ 近端瓣膜损害较显著近端瓣膜损害较显著 ⒊⒊ 总血流动力学异常明显总血流动力学异常明显
- 110. 贵阳医学院内科教研室心血管科 六、并发症六、并发症 ㈠心律失常㈠心律失常 ⒈⒈ 心房颤动 心房颤动 MSMS MIMI ⒉⒉ 室性心律失常 室性心律失常 AIAI ASAS ⒊⒊ 房室传导阻滞 房室传导阻滞 ASAS
- 111. 贵阳医学院内科教研室心血管科 六、并发症六、并发症 ㈡血栓栓塞㈡血栓栓塞 MSMS MIMI 心房颤动心房颤动 左心房直径＞左心房直径＞ 55mm55mm 脑动脉栓塞最多见脑动脉栓塞最多见
- 112. 贵阳医学院内科教研室心血管科 六、并发症六、并发症 ㈢感染性心内膜炎㈢感染性心内膜炎 AIAI MIMI ㈣急性心源性肺水肿㈣急性心源性肺水肿 MSMS 急性 急性 MIMI 急性 急性 AIAI
- 114. 贵阳医学院内科教研室心血管科 七、治疗七、治疗 ㈠预防风湿热复发、反复发㈠预防风湿热复发、反复发 作作 长期或终身应用卞星青霉素长期或终身应用卞星青霉素 120120 万万 UU MiMi 每月一次 每月一次 预防并发症，保护心脏功能预防并发症，保护心脏功能
- 116. 贵阳医学院内科教研室心血管科 ㈢纠正血流动力学异㈢纠正血流动力学异 常常 ⒈⒈ 经皮球囊瓣膜成形术经皮球囊瓣膜成形术 MSMS ASAS ⒉⒉ 瓣膜成形术、分离术瓣膜成形术、分离术
- 117. 贵阳医学院内科教研室心血管科
- 118. 贵阳医学院内科教研室心血管科
- 119. 贵阳医学院内科教研室心血管科 ⒊⒊ 人工心脏瓣膜置换人工心脏瓣膜置换 术术 生物瓣生物瓣 使用年限有限使用年限有限 1010 年左右年左右 器械瓣器械瓣 需终身抗凝治疗需终身抗凝治疗
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- 122. 贵阳医学院内科教研室心血管科 手术条件手术条件 ⑴⑴ 心功能Ⅱ心功能Ⅱ -Ⅲ-Ⅲ 级级 ⑵⑵ 心功能Ⅰ级伴心脏明显扩心功能Ⅰ级伴心脏明显扩 大大 AIAI MIMI ASAS ⑶⑶ 心功能Ⅳ级需纠正心功能Ⅳ级需纠正 ⑷⑷ 全身情况可耐受手术全身情况可耐受手术
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Editor's Notes
- Rheumatic mitral stenosis. A, Moderate valvular changes including diffuse leaflet fibrosis, commissural fusion, and chordal thickening and fusion. In another patient, an atrial view (B) and subvalvular and aortic aspects (C) show prominent subvalvular involvement; severe subvalvular distortion is evident (arrow). D, Severe rheumatic mitral stenosis with specimen shown in apical four-chamber echocardiographic view, demonstrating small left ventricle (lv) and enlarged left atrium (la), right ventricle (rv), and right atrium (ra). Note the calcified stenotic valve (arrow) and prominent subvalvular changes (double arrows). (A and D from Schoen FJ, St. John Sutton M: Contemporary issues in the pathology of valvular heart disease. Hum Pathol 18:568, 1987.)
- Malar flush of mitral stenosis. This pinkish-purple discoloration has been attributed to vasoconstriction associated with the low cardiac output of severe mitral stenosis.
- Typical malar flush of mitral stenosis.
- Chest radiograph of a patient with mitral stenosis shows mild left atrial enlargement with clear lung fields and a normal-size cardiac silhouette. The left atrial appendage bulge is indicated by the white arrow and the "double-density" due to an enlarged left atrium by the black arrows.
- Parasternal long-axis (A) and short-axis (B) two-dimensional echocardiographic views in mid-diastole show the characteristic findings of rheumatic mitral stenosis. The commissural fusion results in doming of the leaflets in the long-axis view (arrow) and in a decreased width of the mitral orifice in the short-axis view. This patient has relatively thin, flexible leaflets with little subvalvular involvement. Ao = aorta; LA = left atrium; LV = left ventricle; MVA = mitral valve area.
- Two-dimensional transthoracic parasternal short-axis view of the mitral valve orifice during diastole, demonstrating the echocardiographic method of mitral valve area calculation. The innermost border of the mitral orifice was planimetered with the use of a light-pen system to obtain the area (in cm2 ). (Reproduced with permission from Smith MD et al: Comparative accuracy of two-dimensional echocardiography and Doppler pressure half-time methods in assessing severity of mitral stenosis in patients with and without prior commissurotomy. Circulation 73:100, 1986. Copyright 1986 American Heart Association.)
- Rheumatic mitral valve disease is evident in this opened mitral valve with thickening and fibrosis of the leaflets and prominent fusion and shortening of the chordae tendineae. This valve probably was associated with predominantly regurgitant pathology.
- Mitral regurgitation (MR). A 66-year-old woman had a history of shortness of breath and MR. Note regurgitant, nonstenotic mitral valve (MV) with fibrosis. Commissures are fused and fibrotic, and valve leaflets are retracted (arrows). The MV orifice (arrowhead) remains open during systole, producing MR.
- Diagram of parasternal view of two-dimensional echocardiography in normal subject and in patient with MVP. A, Normal parasternal long-axis view at end-diastole immediately preceding mitral valve closure. Labeled are the anterior leaflet (AL), posterior leaflet (PL), ventricular septum (VS), posterior wall (PW), aorta (AO), left atrium (LA), and left ventricle (LV). Systolic prolapse may be predominantly anterior leaflet (B, arrows), predominantly posterior (C, arrow), or both (D, arrows). The presence of leaflet thickening, leaflet redundancy, chordal elongation, and annular dilatation should also be assessed on the two-dimensional study. Color flow and pulsed-wave Doppler studies are used to determine the presence and extent of mitral regurgitation, an important supporting finding in borderline cases. (From Prabhu SD, O'Rourke RA: Mitral valve prolapse. In Rahimtoola SH (ed): Valvular Heart Disease. Atlas of Heart Diseases. Vol. 11. Braunwald E, series ed. Philadelphia: Current Medicine, 1997, pp 10.1–10.18.)
- The echocardiographic appearance of mitral valve (MV) prolapse (< posterior MV leaflet) is demonstrated, as is the utility of two-dimensional echocardiography in defining MV anatomy. AO = aorta; LA = left atrium; LV = left ventricle.
- Mitral annular calcification. An elderly woman had a diagnosis of mitral regurgitation (MR). At autopsy there were calcific nodules in the annulus of the mitral valve (MV). Annular calcification was located at the angle formed by the base of the MV and the left ventricular endocardium (black arrow). A bar of calcium extended to the free margin of the MV (arrowhead), causing chordal rupture (white arrows).
- A, Mitral insufficiency was caused by rupture of the papillary muscle (arrow). The valve and chordae are normal in this surgically resected specimen. B, Close-up view of the ruptured papillary muscle (large arrow) that caused acute mitral regurgitation, a flail leaflet, and twisting of the chordae tendineae (small arrow).
- Chest radiograph in nonrheumatic mitral regurgitation with an enlarged heart and pulmonary congestion. The left atrium is also enlarged.
- The color flow Doppler pattern of disturbed flow produced by the mitral regurgitant jet (MR) is demonstrated in the left atrium (LA). The size of jet is usually proportional to the amount of regurgitation, but because the Doppler pattern represents flow velocity, not quantity, the jet size may over- or underestimate the amount of regurgitation. Jet velocity may also vary according to loading conditions, altering estimation of the amount of MR present. LV = left ventricle; RA = right atrium; RV = right ventricle.
- Chronic rheumatic aortic regurgitation with cuspal fibrosis, thickening, and retraction, with a jet lesion consisting of endocardial fibrosis (large arrow) and a “pocket” (small arrow) below the valve. Warty, small vegetations resulting from acute rheumatic fever are on the aortic valve edge, the aortic and mitral valve leaflets, and the chordae tendinae (open arrow). (From Rozich JD, et al: Mitral valve replacement with and without chordal preservation in patients with chronic mitral regurgitation: Mechanisms for differences in postoperative ejection performance. Circulation 86:7718, 1992.)
- A, Parasternal long-axis two-dimensional echocardiogram shows aortic root dilation in a patient with Marfan syndrome, with characteristic loss of the normal contour of the sinotubular junction (arrows). B, Central AR, identified by color flow imaging, is caused by inadequate central coaptation of the stretched leaflets. Ao = aorta; LV = left ventricle; LA = left atrium.
- The chest radiograph of a patient with chronic compensated AR shows left ventricular enlargement (arrows) but no evidence of pulmonary congestion.
- Types of aortic valve stenosis. A, Normal aortic valve. B, Congenital aortic stenosis. C, Rheumatic aortic stenosis. D, Calcific aortic stenosis. E, Calcific senile aortic stenosis. (From Brandenburg RO, et al: Valvular heart disease—When should the patient be referred? Pract Cardiol 5:50, 1979.)
- Calcific aortic stenosis. A, Congenitally bicuspid aortic valve, characterized by two equal cusps with basal mineralization. B, Congenitally bicuspid aortic valve having two unequal cusps, the larger with a central raphe (arrow). C, Otherwise anatomically normal tricuspid aortic valve in an elderly patient, characterized by isolated cusps with calcification localized to basilar aspect; cuspal free edges are not involved. D and E, Photomicrographs of calcific deposits in calcific aortic stenosis; deposits are rimmed by arrows (hematoxylin and eosin, original magnification 15). D, Deposits with underlying cusp largely intact; transmural calcific deposits are shown in E. (A and C from Schoen FJ, St. John Sutton M: Contemporary issues in the pathology of valvular heart disease. Hum Pathol 18:568, 1987.)
- A, Posteroanterior (PA) chest radiograph of an adult with valvular aortic stenosis shows a normal cardiac silhouette with mild dilation of the ascending aorta (double arrows). B, The lateral view shows calcification of the aortic valve (arrow).
- A 68-year-old white man, with history of acute rheumatic fever at age 14 and a longstanding heart murmur, had remained asymptomatic from age 14 to 61 years, when he developed dyspnea on exertion and paroxysmal nocturnal dyspnea. Significant mitral stenosis (MS) was documented with a mitral valve area of 0.67 cm2, a mitral gradient of 14 mm Hg, and mild mitral regurgitation. Note a markedly dilated left atrium (LA) and MS (black arrow). White arrow indicates the intraatrial septum.
- Inoue's percutaneous mitral commissurotomy technique. A, Inflation of the distal portion of the balloon, which is thereafter pulled back and anchored at the mitral valve. B, Subsequent inflation of the proximal and middle portions of the balloon. At full inflation, the waist of the balloon in its midportion has disappeared. (From Topol E [ed]: Textbook of Interventional Cardiology, Update 3. Philadelphia, WB Saunders, 1991, p 31.)
- Transvenous technique using the combination of a trefoil and a conventional balloon. (From Topol E [ed]: Textbook of Interventional Cardiology, Update 3. Philadelphia, WB Saunders, 1991, p 31.)
- A, The Starr-Edwards caged ball valve. B, The Omniscience valve. C, The Medtronic-Hall valve. D, The St. Jude bileaflet valve. E, The Carbomedics bileaflet valve. (From Cohn, LH: Aortic valve prostheses. Cardiol Rev 2:219, 1995.)
- A, Hancock porcine valve. B, Carpentier-Edwards porcine valve. C, Carpentier pericardial valve. D, Cryopreserved homograft valve. E, Incisions for placement of pulmonary autograft valve into the aortic position. (From Oury JH: Pulmonary autograft—past, present and future. J Heart Valve Dis 2:366, 1993.)