Increased pulmonary blood

Introduction Aortic valve insufficiency, usually asymptomatic, but once the disease, the disease progresses rapidly, the left heart bulge is caused by aortic valve insufficiency, the increase in pulmonary blood is due to high left ventricular pressure, causing high left atrial pressure, and then Causes congestion in the lungs. Mild and moderate patients have no obvious symptoms, and severe patients feel palpitations. The left lateral position is prone to left chest discomfort. Left heart failure can be weak, difficulty breathing, or acute pulmonary edema, the development of the disease can cause right heart failure.

Cause

Aortic regurgitation is mainly caused by rheumatic aortic valve disease, and can also be caused by infectious aortic valve disease, as well as aortic atherosclerosis and syphilitic aortitis involving the aortic valve. In addition, syphilitic aortitis, rheumatoid aortitis, and Marfan syndrome can cause enlargement of the annulus and cause relative aortic regurgitation.

an examination

Related inspection

Doppler echocardiography cardioangiography electrocardiogram

1. Imaging examination

(1) X-ray: typical manifestations of left ventricular enlargement, enlargement of the left atrium, shift of the apex to the left and the enlargement of the aortic root. Syphilitic aortitis, Marfan syndrome, aortic dissection, etc. can be seen as ascending aorta dilatation or with calcification. Pulmonary congestion and interstitial pulmonary edema can be seen in patients with left heart failure.

(2) Echocardiography: It is the most useful non-invasive method for diagnosing aortic valve disease and determining the size of the aortic annulus and ascending aorta. It is of great value for identifying the cause, assessing the size and function of the left ventricle, and the severity of reflux. The left ventricular end-systolic diameter <55 mm is the limit of surgery to reverse the left ventricular dilatation. Aortic valve replacement should be performed before the ventricular expansion reaches this limit.

(3) CT, magnetic resonance: can clearly show the aortic valve anatomy, for the diagnosis of aortic diseases, such as aortic dissection, has a very high diagnostic value, especially magnetic resonance, can do sagittal section scan. It is clear that the aorta is most sensitive to full length.

2. Other inspections

(1) Electrocardiogram: typical manifestations of left atrial enlargement and left ventricular hypertrophy with strain. There was no left ventricular hypertrophy in acute aortic regurgitation, common sinus tachycardia and ST-T changes suggesting myocardial ischemia.

(2) Cardiac catheter: used to identify other associated diseases, such as mitral regurgitation and exploration of coronary lesions.

Differential diagnosis

1, pulmonary blood flow is very small: symptoms of tricuspid atresia patients with longevity and pulmonary blood flow are closely related. Pulmonary blood flow is close to normal, the survival period is up to 8 years, and the pulmonary blood flow is very large. After birth, it can only survive for 3 months. If the pulmonary blood flow is less than normal, the postnatal survival period is in the above two cases. between. Keith et al reported that 50% of patients with tricuspid atresia can survive to 6 months, 33% survive to 1 year old, and only 10% can survive to 10 years. Cases with small septum in the room showed clinical systemic venous congestion, jugular vein engorgement, hepatomegaly and peripheral edema. Due to the small amount of blood in the pulmonary circulation, most cases can appear purpura from the neonatal period, and they are anxious after exertion, and can take the position of sputum or hypoxic fainting. The clubbing (toe) often occurs in patients over 2 years of age. In cases of increased pulmonary blood flow, the degree of purpura is reduced, but often there is shortness of breath, rapid breathing, prone to pulmonary infection, often present with congestive heart failure.

2, a lot of pulmonary blood flow: the length of life of patients with tricuspid atresia is closely related to pulmonary blood flow. Pulmonary blood flow is close to normal, the longest survival period can be more than 8 years; many patients with pulmonary blood flow can only survive for 3 months after birth. Tricuspid atresia is a kind of cyanotic congenital heart disease, the incidence rate is about It accounts for 1 to 5% of congenital heart disease. In the cyanotic congenital heart disease, the fourth place was after the tetralogy of Fallot and the aortic dislocation. The main pathological changes were tricuspid atresia or tricuspid valve loss, patent foramen ovale or atrial septal defect, mitral and left ventricular hypertrophy, right and ventricular dysplasia.

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