严重二尖瓣狭窄 Severe Mitral Stenosis 教育頭條網

【Severe Mitral Stenosis 严重二尖瓣狭窄】

Parasternal adj.胸骨旁的

Transthoracic adj.经胸的

Transmitral adj.经二尖瓣的

A 47-year-old man presented to the emergency department with a 6-month history of worsening exertional dyspnea. He had recently emigrated from Honduras and had a history of cardiac surgery as a child, but the initial diagnosis and specific procedure that had been performed were not known. The physical examination revealed a right parasternal heave, a loud S1, a midpeaking systolic ejection murmur(grade 2/6) at the upper sternal border, and a low-pitched diastolic rumble at the apex. An electrocardiogram showed atrial flutter with variable atrioventricular conduction. Transthoracic echocardiography revealed moderate aortic stenosis and very severe mitral stenosis (see video at NEJM.org). The left atrium was enlarged, with an indexed atrial volume of 364 ml per square meter. Color flow Doppler images and a continuous wave Doppler flow pattern showed the stenotic mitral valve during diastole. The slow decline in transmitral flow velocity reflects the very slow decrease in left atrial pressure and slow increase in left ventricular diastolic pressure that occur in mitral stenosis. The patient underwent replacement of the mitral and aortic valves with mechanical prostheses. At a 6-month follow-up visit, he had only slight limitations on physical activity.¹

【译文】一名47岁男子因劳累性呼吸困难加重6个月急诊就诊。最近他从洪都拉斯移民来美国，有儿时心脏手术史，但最初的诊断和具体实施的手术不详。体格检查显示右侧胸骨旁可见隆起、第一心音响亮、胸骨边缘上部收缩中早期喷射性杂音（2/6级）以及心尖部低调的舒张期隆隆样杂音。心电图显示心房扑动伴有房室传导比例不定。经胸超声心动图显示中度主动脉瓣狭窄和严重的二尖瓣狭窄（在NEJM.org上观看视频）。左心房扩大，心房容积指数为每平方米364毫升。彩色血流多普勒图像和连续波多普勒血流模式显示舒张期的狭窄二尖瓣。经二尖瓣血流速度缓慢下降，反映了发生在二尖瓣狭窄的左心房压力缓慢降低和左心室舒张压缓慢增加。患者进行二尖瓣和主动脉瓣的机械瓣置换术。6个月随访中，患者只有轻微的身体活动受限。

【医学单词记忆之道】

1. 常用医学词组

exertional dyspnea

劳力性呼吸困难

atrial flutter 心房扑动

atrioventricular conduction

房室传导

aortic stenosis 主动脉瓣狭窄

mitral stenosis 二尖瓣狭窄

left atrium 左心房

color flow Doppler image

彩色血流多普勒图像

a continuous wave Doppler flow pattern

连续波多普勒血流模式

left ventricular diastolic pressure

左室舒张压

2. 常用英语表述方式

364 毫升/平方米表述为

364 milliliter per square meter

【医学英语延伸阅读】

Mitral stenosis means that the valve cannot open enough. As a result, less blood flows to the body. The upper heart chamber swells as pressure builds up. Blood and fluid may then collect in the lung tissue (pulmonary edema), making it hard to breathe. In adults, mitral stenosis occurs most often in people who have had rheumatic fever. This is a disease that can develop after an illness with strep throat that was not properly treated.

The valve problems develop 5 to 10 years or more after having rheumatic fever. Symptoms may not show up for even longer. Rheumatic fever is becoming rare in the United States because strep infections are most often treated. This has made mitral stenosis less common.

Rarely, other factors can cause mitral stenosis in adults. These include calcium deposits forming around the mitral valve, radiation treatment to the chest, and some medicines.

Children may be born with mitral stenosis (congenital) or other birth defects involving the heart that cause mitral stenosis. Often, there are other heart defects present along with the mitral stenosis.

Mitral stenosis may run in families.²