's general knowledge of summary of tricuspid stenosis

's general knowledge of summary of tricuspid stenosis
Three sharp sharp one alone is narrow and extremely rare in rheumatism. Tricuspid stenosis, nearly all with a pathological change of bicuspid valve and/or aorta, and there are tricuspid valves that can not be closed completely. As sequela of rheumatic fever, it is similar to mitral stenosis that pathology is changed, namely valve fiber take, increase thick, edge have superfluous living beings grow, three the intersection of valve and mutual adhesion or merge, form the narrow holes of triangle. Pathological change can also prolong and chorde tendinae and papilla skin. But intensity and range of tricuspid valve pathological change are lighter than bicuspid valve, it is rare to merge under the valve, and seldom there is calcium that is deposited. Narrow after taking shape, the obstacle happens when the blood flow flows into the right ventricle from the atrium dextrum, therefore the atrium dextrum is expanded, the pressure rises. Because of the reflux blockage of vena cava, venous pressure is raised for a long time, signs such as intravenous anger one of neck, hepatomegaly, ascites and four limbs edema,etc. appear. The right ventricle withers because of reducing in blood flow volume. When with bicuspid valve pathological change, the right ventricle is very plump.
' diagnose '
The simple tricuspid stenosis case is still easy to diagnose, but the persons who are uniting valve pathological change, tricuspid stenosis is often easy to be ignored, should maintain vigilance. Carry on the right heart conduit inspection if necessary. Specific suspicious case, in the operation, handle and mean ascertaining in the heart the atrium dextrum can be diagnosed clearly.
' treat the measure '
Treatment of tricuspid stenosis, in principle the same as mitral stenosis, but person who close expand, separate skill to be apt to tear valve, lead to the fact, shut off the wholly seriously, have not advocated employing yet at present.
(1) Cut the skill and suitable for merging, well organized case of valve of simple juncture in the juncture of tricuspid valve. Cut-out atrium dextrum,it down by knife petal before not cutting respectively direct-view and it separate on petal and after petal and integration juncture to separate petal, disengage it into two each leaves. Before it cut petal with after there merge being easy to be produce is juncture of petal, so should be cautious.
(2) The tricuspid valve replaces the skill and suitable for the valve and damages the deformity or shuts to the persons who can not be closed completely of cake seriously. The operation is cut-outed by the atrium dextrum. Excise valve, put suture and put artificial step of valve into basically until bicuspid valve replace skill to be same. But should notice: A ring structure of tricuspid valve is not tough and tensile enough, it needs to take the spacer so as not to tear to wear the cotton-padded mattress type suture which sews a ring; Can't cross a ring through the position suture of a leaf, so as not to damage and conduct bunch; Seeing that the apt to take place postoperative thrombus of tricuspid valve, the pressure that and the valve bears and has smaller bicuspid valve position than the aorta one, it is comparatively suitable to replace the artificial living beings one.
' clinical manifestation '
The main symptom of tricuspid stenosis is caused by gastrointestinal tract and stagnation of the blood of liver spleen, such as discomfort, losing the appetite, indigestion and abdominal distension in the liver district,etc.. With weak and four limbs edema sometimes. Simple tricuspid stenosis, there are many and non- obvious heart and lungs symptoms, with the patient of the mitral stenosis, also because right ventricle blood flow volume is reduced, heart and lungs symptom is lighter than simple mitral stenosis person.
Physical examination visual surface cheek slight cyanosis and jaundice ' The stagnation of the blood of chronic liver causes) . The intravenous anger one of neck, even beat. Hepatomegaly, the quality is relatively hard, touch a tender spot, can lay one's hand on to beat before systolic phase sometimes. The person who has ascites, the belly swells, there are voiced sounds of mobility. When the heart is checked, the heart voiced sound circle expands to the right side. The first sound of tricuspid valve district is hyperfunction, can pat and hit the sound open after the second sound. Can hear a cylinder and one kind of noises of relaxation before systolic phase among the 4th rib of left reason of brestbone, can touch and tremble sometimes. While inhaling deeply, because thorax negative pressure increases, the blood flow volume of atrium dextrum increases, the noise is obviously strengthened, can distinguish with the mitral stenosis.
' auxiliary examination '
X-ray examination: And then before show location photo expand right heart reason underpart right,superior vena cava it is wide for the shades to increase. Simple tricuspid stenosis, the lung is wild and clear, and there is no lung artery expanding or stagnation of the blood of lung.
The electrocardiogram characteristic is that P wave increases, but there is no plump phenomenon of right ventricle.
Pursue to check in the supersound aroused in interest: The echo wave of the tricuspid valve is similar to mitral stenosis, the tricuspid stenosis patient, the bimodal curve disappears, section EF is lowered and slowed down rapidly, present the pier kind and change. The relaxation one is abnormal through an activity, the atrium dextrum is expanded; When the end of right ventricle relaxation presses to rise, lengthen during AC. Tangent plane supersound aroused in interest to pursue, reveal tricuspid valve valve increase thick, relaxation issue open activity to be restricted.
The right heart conduit checks to reveal the pressure of atrium dextrum obviously increases. Atrium dextrum and right ventricle have the bad steps of a pressure of relaxation before prominent systolic phase, it is generally 0.5- 1.1kPa (4- 8mmHg) .
The radiography of cardiovascular vessel is checked: Locate in the atrium dextrum on the conduit top. Oblique the intersection of location and film take a photograph of slice, can reveal tricuspid valve a leaf increase thick, the activity subsided in front of the right, radiography pharmaceutical flows into the right ventricle in the relaxation one through narrow holes, and atrium dextrum radiography pharmaceutical empties time to lengthen.
' differential diagnosis '
Atrium dextrum mucus tumour, when blocking a hole in tumour, can also cause the clinical manifestation of tricuspid stenosis, but the medical history is short, the course of disease develops fast, pursue to have the unique vaporific picture of cloud in the supersound aroused in interest, can be distinguished.
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