Tricuspid stenosis tricuspid stenosis_ general knowledge

Tricuspid stenosis tricuspid stenosis_ general knowledge
Summary
Tricuspid stenosis (tricuspid stenosis) Cause a area of tricuspid valve to diminish for various reasons. Women meet more.
Cause of disease The most common cause of disease of tricuspid stenosis is rheumatic fever, about 15% have tricuspid stenosis in the rheumatic heart disease patient, but only 5% of clinical persons who can diagnose clearly. Other inborn tricuspid valve locking, right room tumour and a kind of cancer syndrome that there are the cause of diseases rarely. The clinical feature of the right room tumour is that symptom develops fast; Kind of cancer syndrome is often with the backflow of tricuspid valve at the same time. Rheumatism tricuspid stenosis seldom exists alone, nearly with a pathological change of bicuspid valve, aorta at the same time, mostly the mitral stenosis.
Pathology Change pathology to change and is similar to mitral stenosis, but it is relatively light to damage. It is obvious the chorde tendinae is merged and shortened, 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. The atrium dextrum is obviously expanded, the atrium wall is increased thick, can also present the signs of serious viscera blood stasis such as liver, splenomegaly.
Pathologic physiology Tricuspid stenosis, the blood flows into the right room from the right room and is obstructed, present a pressure rank of relaxation badly between atrium dextrum and right ventricle (step one to press) . When or inhale to make the blood flow volume of tricuspid valve increase in sports, step one to press and increase promptly; When exhaling makes the blood flow of tricuspid valve reducing, it can be reduced that the rank of this pressure is bad. If a pressure rank of average relaxation exceeds 0.67kPa( 5mmHg) badly When, can make the average right room press and raise and cause the intravenous extravasated blood of the systemic circulation, showing as the neck vein is full of, hepatomegaly, ascites and edema,etc.. The right ventricle heart arranges blood volume to drop, does not sometimes increase with sports; So the atrium sinistrum was pressed, lung arterial pressure and right ventricle can not obviously rise to press.
Clinical manifestation
(1) Symptom
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.
(2) Physical sign
1.Noise of roaring in the later period in a kind of relaxation in a low-key attitude of left bottom flange of brestbone of heart auscultation, strengthen before systolic phase. Upright location noise strengthen inhale, 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.
2.Tricuspid stenosis of other physical sign often has physical sign of extravasated blood of obvious right heart, such as the neck vein is full of, have obvious " a " The wave, 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.
Laboratory and other inspections
(1) Increase X-ray examination heart shadow obviously,back before see atrium dextrum not expanded location right heart reason obviously, the superior vena cava is outstanding, but there is not lung arteriectasis. The maximum distance from centre line of the right room edge is greater than 5cm. (2) It is loose to check the atrium dextrum the electrocardiogram, 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.
(3) What the supersound aroused in interest is observed while pursuing to check change and mitral stenosis of the tricuspid valve is similar, M -type supersound pursue, reveal petals of leaf increase thick, the intersection of EF and slope of frontal lobe slow down, the intersection of relaxation and with separate one, take the form of contradictory sport, the intersection of tricuspid valve and calcification and increase thick issue often while being aroused in interest; Two-dimentional supersound aroused in interest to pursue to diagnose relatively helpful tricuspid stenosis, its characteristic is that a leaf of relaxation takes the form of the garden and joins the form, increase thick, a leaf is movable and limited. Doppler's supersound can be seen a right ventricle side high speed of tricuspid valve " The flame shape " Efflux.
(4) The heart conduit checks and shows the right room to press and increase to step one and press difference with the tricuspid valve.
Diagnose it according to typical noise, atrium dextrum expanding and symptom and physical sign of systemic circulation extravasated blood, can generally make diagnosis, the feasible right heart conduit inspection of the person who has difficulty on diagnosing, if the tricuspid valve steps difference of a diastolic pressure in 0.27kPa( 2mmHg) equally The above, can diagnose as tricuspid stenosis.
Differential diagnosis
1,Atrial septal defect divide the intersection of flow and large atrial septal defect into can hear very brief relaxation middle period in the intersection of tricuspid valve and district " Roar " Kinds of noise, but the intersection of artery and petals of district second sound hyperfunction with the intersection of systolic phase and noise and lung among the the intersection of brestbone and left the intersection of reason and the second and the third rib at the same time. Pursue to be able to be made a definite diagnosis of in the supersound aroused in interest.
2,One kind of noises that the low-key one roars of later period in relaxation in the apex of the heart of mitral stenosis district, present the increasing progressively type, limitation, obvious while lying on the left side in the location, has not changed or weakened while inhaling, can tremble with the relaxation one. Can present lung artery ing, a second sound is hyperfunction and split. Hear among the intersection of brestbone and left the intersection of reason and 2- 4 rib and Graham-Settll noise. The serious mitral stenosis patient can present the flush bicuspid valve face of two cheekbones. The supersound aroused in interest is pursued and can be diagnosed clearly.
Treat
First, treatment of internal medicine department restrain 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; Control ventricle rate with digoxin when the room is quiver.
Second, surgery treatment if symptom is obvious, the average diastolic pressure Damien 0.53- 0.67kPa (4- 5mmHg) of right ventricle ,When being smaller than 1.5- 2.0cm2 with a area of tricuspid valve, can make tricuspid valves and separate the skill or expand shaping skill of the valve by the ball bag, it is feasible for artificial valve to replace skill, you had better take the intersection of living beings and petal also.
Prognosis
The prognosis of tricuspid stenosis is closely related to narrow intensity, the narrow slightly one can have no symptom for a long time, severe the narrow one presents symptom early, prognostic difference.
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