心瓣膜病,老年性心瓣膜病,老年心衰

老年性心瓣膜病应该做哪些检查?

  1. 心电图 – 轻度老年性钙化性瓣膜病心电图正常。主动脉瓣病变者可有左室肥大图形。二尖瓣环钙化者除左室肥大外。可有左房增大所致的P波时限延长或出现切迹,V1导联ptf负值增大。由于本病常累及心脏传导系统,故常有一至三度房室传导阻滞、左束支阻滞或左前半阻滞图形。20%~30%患者可出现房颤或其他心律失常。
  2. 超声心动图 – Takamoto等将超声与尸检或手术后病理检查对照分析,发现超声诊断的敏感性约为70%,是目前临床诊断本病的主要手段。二维超声心动图可直接观察瓣膜钙化的部位、形态和瓣叶的运动情况,但难以对瓣口狭窄的程度作定量判断。超声多普勒及彩色多普勒血流显像则较好地解决了这一问题。最近研究发现,以多普勒连续波测定跨瓣压力阶差及瓣口面积与用导管所测的结果相关性良好(r=0.75,P=0.002),使超声在检出钙化性瓣膜病,判断病变位置和程度的灵敏性和特异性大为提高。不仅可对血流动力学改变进行监测,评价瓣膜功能,为临床病情分析、指导治疗、预后判断提供帮助,而且还可为选择手术适应证和手术方式提供客观依据。
    • 老年主动脉瓣钙化性变的特征性改变是瓣膜局部明显异常的增厚、活动度减低、瓣膜启闭功能障碍、因钙化而使回声明显增强,尤以瓣环和瓣体部明显,若累及室间隔膜部也可有相应回声增强。何军等以瓣膜瓣环钙化大于主动脉根部回声为诊断标准,而以主动脉壁作为超声评价心瓣膜钙化的内参照点,可能是一种直观而实用的方法。其他可见一般主动脉狭窄和闭锁不全的征
      象。
    • 二尖瓣环钙化时在M型超声心动图进行心前区扫描时,可发现左室后壁前方,紧接二尖瓣后瓣之后出现一条异常宽的、反射强烈、与左室后壁平行的回声带,提示瓣环的钙化。并可见二尖瓣前叶活动振幅减小,EF斜率缓慢以及左室扩大等。二维超声检查心前区短轴观显示二尖瓣后叶和左室后壁间有一致密新月形回声带。心前区长轴观或心尖区探查可显示房室交界处的前方出现一团异常的强回声带,此回声的运动方向与左室后壁运动方向一致,且与左房和左室不相连。发生关闭不全时多普勒可显示在左房内收缩期血液返回所引起的湍流,声学造影时可见造影剂在收缩期由左室返回左房。
  3. X线和CT检查 – 普通胸片可显示主动脉结钙化,高曝光技术或断层摄片可提高检出率。如在主动脉和(或)二尖瓣环处出现斑片状、线状或带状钙化阴影,有助于诊断。此外可出现主动脉瓣和二尖瓣狭窄与闭锁不全相应的X线征象。另外,Woodring等报道对于某些超声未能检出的早期老年钙化性瓣膜病。CT可提高检出率,且认为比超声有更高灵敏性和特异性,但目前尚不是常规的检测方法。

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