嚴重二尖瓣狹窄 Severe Mitral Stenosis 教育頭條網

【Severe Mitral Stenosis 嚴重二尖瓣狹窄】

Parasternal adj.胸骨旁的

Transthoracic adj.經胸的

Transmitral adj.經二尖瓣的

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

【譯文】一名47歲男子因勞累性呼吸困難加重6個月急診就診。最近他從洪都拉斯移民來美國，有兒時心臟手術史，但最初的診斷和具體實施的手術不詳。體格檢查顯示右側胸骨旁可見隆起、第一心音響亮、胸骨邊緣上部收縮中早期噴射性雜音（2/6級）以及心尖部低調的舒張期隆隆樣雜音。心電圖顯示心房撲動伴有房室傳導比例不定。經胸超聲心動圖顯示中度主動脈瓣狹窄和嚴重的二尖瓣狹窄（在NEJM.org上觀看視頻）。左心房擴大，心房容積指數為每平方米364毫升。彩色血流多普勒圖像和連續波多普勒血流模式顯示舒張期的狹窄二尖瓣。經二尖瓣血流速度緩慢下降，反映了發生在二尖瓣狹窄的左心房壓力緩慢降低和左心室舒張壓緩慢增加。患者進行二尖瓣和主動脈瓣的機械瓣置換術。6個月隨訪中，患者只有輕微的身體活動受限。

【醫學單詞記憶之道】

1. 常用醫學詞組

exertional dyspnea

勞力性呼吸困難

atrial flutter 心房撲動

atrioventricular conduction

房室傳導

aortic stenosis 主動脈瓣狹窄

mitral stenosis 二尖瓣狹窄

left atrium 左心房

color flow Doppler image

彩色血流多普勒圖像

a continuous wave Doppler flow pattern

連續波多普勒血流模式

left ventricular diastolic pressure

左室舒張壓

2. 常用英語表述方式

364 毫升/平方米表述為

364 milliliter per square meter

【醫學英語延伸閱讀】

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