Diagnosis and getting involved to treat _'s treatment of tricuspid stenosis

Diagnosis and getting involved to treat _'s treatment of tricuspid stenosis
1.Summary Tricuspid stenosis (tricuspid valve stenosis) Mean it causes the heart to obstruct when a issue of blood of relaxation flow into the right room from the right room that the disease of the tricuspid valve is decreased, single tricuspid valve pathological change is few, many to coexist with bicuspid valve disease. Tricuspid stenosis is a relatively rare disease, the case patient who we got involved is inborn men, the literature report sees more women, the overwhelming majority is caused by rheumatic fever, similar to mitral stenosis, the pathology of rheumatism tricuspid stenosis can see the chorde tendinae to merge and shorten while changing, the peak of a leaf merges, form a diaphragm one kind of holes. Tricuspid stenosis can amalgamate the tricuspid valve and can not close completely or exist with the damage of any other valves at the same time. Can cause the atrium dextrum to obviously expand after tricuspid stenosis, the atrium wall is increased thick, can also present the liver, the signs of serious viscera blood stasis such as splenomegaly.
2.It is rheumatism that the cause of disease is the most common, the overwhelming majority is caused by rheumatic fever, I haven't seen you for a long time the reason has an inborn one, if the inborn tricuspid valve is locked, right room tumour and a kind of cancer and syndrome cancer pathological change, membrane elasticity fibrous hyperplasia disease and right room mucus tumour,etc. in the heart. The ones that develop fast in symptom see right room tumour, a kind of cancer syndrome is often with the backflow of tricuspid valve at the same time. Rheumatism tricuspid stenosis seldom exists alone, nearly with bicuspid valve pathological change at the same time, mostly the mitral stenosis. About 15% have tricuspid stenosis in the rheumatic heart disease patient, but the clinical persons who can diagnose clearly are only 5%.
3.The physiological tricuspid valve of pathology if it is due to rheumatism, the adhesion at the place where rheumatic fever leave over juncture of tricuspid valve after curing, but petals of leaf increase thick, tricuspid valve intersection has adhesions, take the form of diaphragm, it is not complete that the rheumatism person often accompanies and closes. Normal the intersection of tricuspid valve and the intersection of mouth and upper and lower relaxation issue pigeonhole difference to be obvious, tricuspid stenosis make atrium dextrum and appear the intersection of relaxation and issues of steps poor pressure between the right ventricle. As sport or inhale, make the intersection of tricuspid valve and blood flow volume increase, relaxation issues of right room and pressure steps between the right room increase badly promptly; When exhaling and making the blood flow of tricuspid valve reduce, it can be reduced that the rank of this pressure is bad. If a pressure rank of average relaxation exceeds 0.53 kPa( 4mmHg) badly When, can make the average right room keep and raise and cause intravenous extravasated blood of the body, press difference and is greater than 0.7 kPa( 5 mmHg) after tricuspid stenosis When, can present the intravenous extravasated blood phenomenon of the systemic circulation. Showing as the neck vein is full of, hepatomegaly, ascites and edema,etc.. The atrium dextrum a wave extremely increases, can reach the level of the systolic pressure of right ventricle at the time of sinus rhythm of the heart. The quiet interest heart arranges blood volume to drop, has not also increased at the time of sports, so the atrium sinistrum is pressed, lung arterial pressure and right ventricle can not obviously rise to press. Because the vena cava is very great in volume, resistance is very low, extravasated blood of right room and raised symptom of the pressure are far lighter than mitral stenosis, the pressure difference among the right room rooms, seldom exceed 2.0 kPa( 15 mmHg) . While existing with the mitral stenosis at the same time, the right heart arranges blood volume to reduce, can relieve the lung artery high pressure that the mitral stenosis causes, lighten lung extravasated blood, is having difficulty in breathing and improving instead.
4.The clinical symptom patient can have breathing hard, subjective symptoms that the tired and belly is uncomfortable,etc.. Tricuspid stenosis due to low heart arrange blood volume, cause tired, body intravenous blood stasis can cause getting obstinate edema, the intersection of liver and the intersection of swelling, ascites,etc. and the intersection of digestive tract and symptom and whole body uncomfortable sense, because neck intravenous enormous " a " that beats The wave, there is sense of beating to make patients feel the shank. Though patient amalgamate have mitral stenosis at the same time often, clinical symptom of mitral stenosis and acute lung edema rare such as spit blood, not popping to have difficulty in breathing night. If the patient has physical sign of obvious mitral stenosis and not has at the time of congested clinical manifestation of lung, should consider that may amalgamate tricuspid stenosis at the same time.
5.Physical sign
There is one kind of noises in low-key relaxation among heart auscultation brestbone left bottom flange or rib of left reason 3~5 of the brestbone 5.1, strengthen before systolic phase, the noise extends to the apex of the heart department sometimes, can tremble, the liver fluctuates before systolic phase. Right lie on one's side location inhale and upright location noise strengthen inhale, deeply, or the intersection of Valsalva and movement hold one's breath issues of noise subside exhale. Can accompany the intersection of relaxation and issue tremble, can have, turn on one make, hit transliteration. A second sound of lung artery is normal or weakens. The rheumatism person often accompanies the mitral stenosis, the latter often conceals the physical sign of a disease.
5.2 other physical sign neck veins are pressed and raised equally, tricuspid stenosis often has physical sign of extravasated blood of obvious right heart, if the neck vein is full of, with obvious " a " Involve Y to prop up and drop slowly. ,Strengthen while exhaling. There can be hepatomegaly in the case in later period, splenomegaly, jaundice, malnutritive seriously, the full-length edema and ascites. The swelling liver can be presented and beaten before obvious systolic phase.
6.Diagnosis
6.1, according to the intersection of venous system and extravasated blood, typical the intersection of tricuspid stenosis and noise, symptom and physical sign that the atrium dextrum expands can make diagnosis generally, the person who has difficulty on diagnosing feasible right heart conduit check, if the tricuspid valve steps difference of a diastolic pressure in 0.27kPa( 2mmHg) equally The above, can diagnose as tricuspid stenosis. Should pay attention to diseases such as narrow pericarditis,etc. with the right room mucus tumour, contract to distinguish.
6.2 electrocardiogram P 2,it high when lasting amplitudes wide AVF,it is close not can room schemes plumps more right at the same time full-timelying not to last tricuspid valve. The atrium dextrum is loose, 2 and 1 lead and unite P wave high and sharp; Amalgamate mitral stenosis at the same time because of most tricuspid stenosis patients, so the electrocardiogram also often shows one pair of atriums loosely. There is no manifestation of right ventricular hypertrophy.
6.3 the intersection of right heart and conduit check, tricuspid valve the intersection of relaxation and issue present, step petals of steps poor pressure, the right room is pigeonholed and increased.
What 6.4 supersound aroused in interest is observed while pursuing to check change and mitral stenosis of the tricuspid valve is similar, M -type supersound aroused in interest to pursue, reveal petals of leaf increase thick, tricuspid valve frontal lobe drop while being oblique type while being flat on the intersection of relaxation and issue often, EF slope of the frontal lobe is slowed down, the relaxation one takes the form of contradictory sport, tricuspid valve calcification with separating one and increases thick; Two-dimentional supersound aroused in interest to pursue to diagnose relatively helpful tricuspid stenosis, characteristic its whether the intersection of relaxation and issues of petals of leaf take the form of the garden and carry the form, a leaf increase the thick, echo, strengthen, a leaf activity is opened limitedly. Its open range is smaller than the diameter of the tricuspid valve ring. Doppler's supersound can be recorded to a turbulance of relaxation on the side of right room of tricuspid valve, can estimate and examine and step a pressure rank badly.
6.5X line heart such as right room obviously increases, lower vena cavas and azygos veins are expanded, the lung artery is not expanded, there is little blood of lung.
7.Treat
7.1 generally treats and restrains sodium salt from taking in strictly, employ diuretic and can improve symptom and physical sign of extravasated blood of the systemic circulation, especially lighten liver extravasated blood, improve liver function. To the surgery, the patient having tooth pulled out employs antibiotic before the skill in order to prevent membrane inflammation in the infective heart. Select the following medicines for use prudently according to patient's individual situation: Such as foreign digitalis, diuretic is anticoagulatory
|