获得性心脏病

Acquired Heart Disease Valvular Heart Disease, Ischemic Heart Disease, and Others Valvular Heart Disease Stenosis Regurgitation (Insufficiency) Mitral stenosis Rheumatic fever, congenital Commissure fusion, chordae thickening LA, PV pressure increase PVP; 25mmHg, interstitial/ alveolar edema R/O myxoma MS: Chest PA CT ratio: normal or increase LA enlargement - Double contour - LA appendage bulging - Lt main bronchus elevation - Esophageal displacement PV hypertension findings -Redistribution -interstitial edema (Kerleys B line, Bronchovascular cuffing) MS MS: CT Thickened MV and restricted MV opening Diastolic doming of MV Decreased MV orifice size (planimetry) LA enlargement LA thrombus Pulmonary venous hypertension MS Mitral Regurgitation Valve deformity, chordae rupture LA, LV volume overload LA enlarged LA pressure PV hypertension, less than in MS MR: chest PA Cardiomegaly LA CT Valve deformity Coaptation (-) LA and LV enlargement Aortic stenosis Stenosis only - congenital 90% Congenital: unicusp, bicuspid, tricuspid Acquired: rheumatic or degenerative Rheumatic origin: usually steno- insufficiency AS: CR and CT Cardiomegaly -not definite LV concentric hypertrophy Post-stenotic dilation -bulging of RUB Calcification of aortic valve Valve thickening Aortic valve area AS Aortic regurgetation Rheumatic endocarditis, bacterial, congential, syphilis, trauma Annulus abnormality: cystic medial nec., Marfan, dissecting an., syphilis, hypertension Congenital: sinus aneurysm, aortic fistula to left ventricle LV volume overload Cardiomegaly & LV enlargement LA enlargement due to LV failure or associated mitral valve disease Enlarged ascending aorta Aortic valvular calcification AS Regurgitation to LV AR: CR, CT, MR AR Courtesy of Choe YH F/25, Marfan Syndrome with AR Ischemic heart disease Ischemic heart disease Coronary arterial stenosis Coronary artery embolism Valvular diseases: AS, AR, MS Anemia, myocardial diseases Coronary angiography , CT, MR PTCA or CABG Ischemic HD: CR, MR, CT Cardiomegaly due to LV aneurysm PV hypertension due to AMI Cx of MI: LV an., MR due to papillary m. rupture Wall motion - hypo-, a-, dys-kinesia Function Coronary artery Ischemic HD: MRI Transmural infarction Subendocardial infarction Perfusion defect Delayed hyperenhancement - Bright is dead ! Chronic MI: thinning & fibrosis MRI of Acute Myocardial Infarction (38/M) Edema Perfusion Defect Delayed Hyperenhancement Function on cine Diastole Systole Diastole Systole Cine MRI Coronary CT angiography Stenosis Plaque character ( stable or vulnerable ) Infarction Stent restenosis, Graft patency Coronary anomaly Cardiac CT LAD RCA Diagonal LCX Plaque character Myocardial disease Hypertrophic CMP -Symmetric, apical hypertrophy - Asymmetrical septal hypertrophy, Idiopathic hypertrophic subaortic stenosis (IHSS) Dilated CMP Restrictive CMP Hypertrophic CMP Cardiac tumors Myxoma - Frequently in LA, pedicle to atrial Septum Mitral stenosis, distant embolism Other benign tumors - Fibroma, rhabdomyoma, lipoma Malignant tumors Angiosarcoma, MFH, lymphoma, fibrosar. Metastasis (22-61%) Cardiac tumor: angiosarcoma Pericardial effusion Bacterial, viral, tuberculous, post-op, post-MI, malignancy, rheumatic fever, myxedema, uremia, connective tissue disease Generalized cardiomegaly with silent lung, sharp cardiophrenic angle Pericardial effusion Constrictive pericarditis Sequela of tuberculous pericarditis Fibrosis and calcifications along atrio- ventricular groove due to organi