皮肤科医生读报:二尖瓣环状钙化

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一位81岁女性因口腔癌术后出现心衰。诊断表明患者围手术期体内水分过多并出现肺栓塞,这导致了患者术后出现心衰。胸片显示心脏部分出现一个大的密集钙化区,与二尖瓣钙化一致。二尖瓣钙化呈半圆形(术前正后位如图A和图B箭头所示,侧位如图C箭头所示)。胸部CT横切面示二尖瓣后外侧出现环形钙化(轴切面如图D箭头所示,短轴切面如图E箭头所示)。胸部超声检查示二尖瓣狭窄和中度返流,左心室舒张功能障碍,左室射心数为69%。老年人的二尖瓣钙化通常通过胸部X线检测到,一般认为是退行性改变,一般无明显临床症状。当二尖瓣钙化较重时,可以引起心脏瓣膜功能障碍(如本例患者),常导致完全性房室传导阻滞,二尖瓣返流,有时也会引起二尖瓣狭窄。二尖瓣钙化可能与糖尿病,高血压,高血脂血症,以及继发于肾衰甲状旁腺功能亢进有关。该患者住院期间通过口服药物进行保守治疗,未进行手术治疗,现已失访。

皮肤科医生读报:二尖瓣环状钙化

Mitral Annular Calcification

An 81-year-old woman was transferred to the medical service with cardiac failure after surgery for oral cancer. A diagnostic workup indicated perioperative overhydration and pulmonary embolism as causative factors for her symptoms. Chest radiography revealed a large, dense area of calcification overlying the heart, consistent with mitral annular calcification. Calcification was semicircular in the location of the mitral valve, as seen on the preoperative posterior–anterior view (Panel A, arrowhead; Panel B, arrow, shows an enlarged view) and a lateral view (Panel C, arrowhead). Computed tomography revealed calcification of the posterolateral mitral-valve annulus on the axial view (Panel D, arrowhead) and the short-axis view (Panel E). Transthoracic echocardiography revealed moderate mitral regurgitation and stenosis, left ventricular diastolic dysfunction, and a left ventricular ejection fraction of 69%. Mitral annular calcification is often detected on routine chest radiographs in elderly patients and is considered to be a degenerative condition that is usually unrelated to clinical symptoms. When mitral annular calcification is massive, it can lead to valvular dysfunction (as in this patient), typically resulting in complete heart block, mitral regurgitation, or less often, mitral stenosis. Mitral annular calcification may be related to diabetes, hypertension, hyperlipidemia, and secondary hyperparathyroidism from renal failure. During her hospitalization, the patient was conservatively treated with oral heart medication. No surgery was performed, and the patient was lost to follow-up.

原文:http://www.nejm.org/doi/full/10.1056/NEJMicm1404772

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