3.acquired valvular heart disease

1
CHAÅN ÑOAÙN HÌNH AÛNH
BEÄNH VAN TIM MAÉC PHAÛI
BS.NGUYEÃN QUYÙ KHOAÙNG
BS.NGUYEÃN QUANG TROÏNG
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2
DAØN BAØI
Heïp van 2 laù.
Ñaïi cöông.
X quang Heïp van 2 laù nheï.
X quang Heïp van 2 laù trung bình-naëng.
Thay ñoåi veà tim.
Thay ñoåi veà maïch maùu.
Thay ñoåi veà chuû moâ phoåi.
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3
DAØN BAØI
Hôû van 2 laù.
Ñaïi cöông.
X quang Hôû van 2 laù nheï.
X quang Hôû van 2 laù trung bình.
X quang Heïp van 2 laù naëng.
Caùc theå keát hôïp.
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4
DAØN BAØI
Heïp van Ñoäng maïch chuû.
Ñaïi cöông.
X quang.
Coäng höôûng töø.
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5
DAØN BAØI
Hôû van Ñoäng maïch chuû.
Ñaïi cöông.
X quang.
Chuïp coù caûn quang.
Coäng höôûng töø.
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6
DAØN BAØI
Beänh lyù van Ñoäng maïch phoåi.
Beänh lyù van 3 laù.
ÖÙng duïng laâm saøng.
Keát luaän.
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7
ÑAÏI CÖÔNG
HEÏP VAN HAI LAÙ
(MITRAL STENOSIS)
Beänh thöôøng gaëp ôû Vieät Nam.
50% laø do Thaáp tim (RAA).Nöõ/Nam=8/1.
Caùc nguyeân nhaân khaùc:
Vieâm noäi taâm maïc nhieãm truøng
(Bacterial endocarditis).
U nhaày nhó (T)(LA myxoma).
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8
ÑAÏI CÖÔNG
HEÏP VAN HAI LAÙ
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9
X QUANG
HEÏP VAN HAI LAÙ NHEÏ
Bình thöôøng S loã van=4-6cm2.
Heïp nheï khi 2cm2 ≤ S < 4cm2.
AÙp löïc mao maïch phoåi =10-12mmHg.
Laâm saøng: Rung taâm tröông (+).
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10
X QUANG
NORMAL MITRAL VALVE MITRAL STENOSIS
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X QUANG
X quang:
Boùng tim chöa thaáy thay ñoåi gì.
Phaân boá maïch maùu phoåi cuõng chöa
thaáy thay ñoåi.
Do vaäy,X quang tim-phoåi bình thöôøng
khoâng loaïi tröø ñöôïc Heïp van hai laù.
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X QUANG
HEÏP VAN HAI LAÙ TRUNG BÌNH-NAËNG
Heïp trung bình khi 1cm2 ≤ S < 2cm2.
AÙp löïc mao maïch phoåi =10-17mmHg.
Heïp naëng khi S loã van < 1cm2.
AÙp löïc mao maïch phoåi ≥18mmHg.
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X QUANG
Sinh lyù beänh:
Taéc ngheõn doøng chaûy töø Nhó (T)
xuoáng Thaát (T) Taêng aùp löïc Nhó (T)
Daõn buoàng Nhó (T) Taêng aùp löïc
TM phoåi Taêng aùp löïc ÑM
phoåi Taêng aùp löïc Thaát (P) Giaõn
buoàng Thaát (P).
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X QUANG
THAY ÑOÅI VEÀ TIM
Daõn buoàng Nhó (T) khi ñöôøng kính Nhó
(T)>7cm (ño töø bôø döôùi PQ goác (T) ñeán
bôø phaûi Nhó (T)).
Pheá quaûn goác (T) bò ñaåy leân cao.
Coù hình aûnh bôø ñoâi ôû bôø (P) cuûa tim.
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15
X QUANG
ÑgMC xuoáng bò ñaåy qua (T).
Phim thaúng coù uoáng Baryte:Thöïc quaûn
coù theå bò ñaåy leäch,thöôøng laø qua (P),ñoâi
khi bò ñaåy leäch qua (T).
Phim cheách tröôùc (P)(RAO) coù uoáng
Baryte:Thöïc quaûn bò ñaåy ra sau roõ nhaát.
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X QUANG
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X QUANG
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X QUANG
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X QUANG
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X QUANG
LEFT ATRIAL ENLARGEMENT is best
confirmed by measuring the distance
from the midinferior border of the left
main bronchus to the right lateral border
of the left atrial density.
-This distance is less than 7cm in 90% of
normal patients and is greater than 7cm
in 90% of left atrial enlargement
patients,as proven by echocardiography.
-This measurement can be approximated
by placing one’s right fifth finger under
the left bronchus,and while keeping the
fingers closed,if the left atrium is seen
beyond one’s four fingertips,the left
atrium is enlarged.
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PULMONARY EDEMA /
MITRAL STENOSIS
AFTER TREATMENT
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X QUANG
MITRAL STENOSIS
Enlarged LAA
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X QUANG
Enlargement of the left atrial
appendage.
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X QUANG
-Elevation of left main bronchus.
-Double shadow of the large left
atrium (arrow).
-Right atrial border is limited
below by the entry of the inferior
vena cava.
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X QUANG
-Elevation of left main bronchus.
-Splaying of the carina.
-Descending aorta (arrow) has
been displaced to the left by the
large left atrium.
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X QUANG
RAO-MITRAL STENOSIS
Enlarged LA
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X QUANG
Caøng ngaøy Nhó (T) caøng to ra,nhaát laø khi
coù Rung nhó.Nhó (T)coù theå vöôït ra ngoaøi
bôø Nhó (P).
Cung ÑMP cuõng to ra do taêng aùp trong
buoàng Thaát (P).
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X QUANG
Tieåu nhó (T) daõn lôùn bieåu hieän baèng cung
thöù 4 beân (T),ngay döôùi cung ÑM phoåi.Ñaây
laø daáu hieäu coù sôùm nhaát cuûa Heïp van 2 laù.
Bôø (T) tim cuõng coù theå bieåu hieän laø moät
ñöôøng thaúng hoaëc loài ra (Mitralisation du
bord gauche du coeur).
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X QUANG
Hieän töôïng Mitralisation roõ laø nhôø Quai
ÑMC nhoû do giaûm cung löôïng tim (löôïng
maùu veà Thaát (T) ít).
Neáu Quai ÑMC to,caàn phaûi chuù yù xem coù
keát hôïp theâm beänh khaùc nhö Heïp van
ÑMC,Hôû van ÑMC.
Quai TM Azygos daõn (>7mm).
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X QUANG
Thaát (T) coù kích thöôùc bình thöôøng,chæ soá
T/N ≤ 0,5.
Veà sau Thaát (P) daõn Chæ soá T/N taêng.
(Khoù chaån ñoaùn phaân bieät vôùi Daøy thaát (T)
treân hình thaúng,caàn hình nghieâng (T)-Thaát
(P) che laáp khoaûng saùng sau öùc).
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X QUANG
Hình aûnh ít gaëp laø voâi hoùa van hai laù(40%),
voøng van 2 laù(10%) vaø ôû thaønh Nhó (T).
Phim nghieâng (T):Nhó (T) to ñaåy PQ goác
(T) ra sau (Walking man sign).

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X QUANG
MITRAL STENOSIS

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X QUANG
-Enlarged veins.
-Bulging of the
pulmonary artery.
-Double density due to
enlarged left atrium.
-Right lateral
displacement of
esophagus.
SEVERE MITRAL STENOSIS

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X QUANG
CHAÅN ÑOAÙN PHAÂN BIEÄT
Pectus excavatum-Cardiac silhouette is rotated and
displaced to the patient’s left,and the left cardiac
border is straight simulating mitral valve disease.

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X QUANG
10-year-old asymptomatic boy
with an unusual contour of the
left upper heart border on a
chest X-ray.

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X QUANG
Coronal T1-weighted:Bulging of the left atrial appendage
related to partial absence of the pericardium.

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X QUANG
PARTIAL ABSENCE OF THE PERICARDIUM

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X QUANG
WALKING MAN SIGN
-The right main bronchus is
outlined.
-The lower lobe bronchus is
displaced posteriorly (large
arrowheads).
-Calcification of the wall of the
left atrium (small arrowheads).

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X QUANG

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X QUANG

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X QUANG
-RAO:enlargement of the left
atrium(large black arrow).
-The mitral valve is calcified(small
black arrow).
-The pulmonary outflow tract is
enlarged(white arrow).

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X QUANG
C-shaped calcification in the mitral
valve ring-Lateral view.
Calcification in the wall of the left
atrium.

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X QUANG
Calcification within
the left atrium.

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X QUANG
Left atrial calcification
(Lateral view).

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X QUANG
-Left atrial calcification
(white arrows).
-Calcified mitral valve
(black arrow).

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X QUANG
-Calcified mitral valve.
-Esophagus is pushed
posteriorly by the
enlarged left atrium.

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X QUANG
Mitral annular calcification in asymptomatic patients.

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X QUANG
THAY ÑOÅI VEÀ TUAÀN HOAØN PHOÅI
Taêng tuaàn hoaøn phoåi thuï ñoäng (Taêng
tuaàn hoaøn phoåi sau mao maïch):
Taùi phaân phoái maïch maùu phoåi xuaát
hieän sôùm khi ALTT>12mmHg.
Xuaát hieän caùc ñöôøng Kerley A,B,C,D
khi ALTT>18mmHg.Thöôøng thaáy nhaát
laø Kerley B.

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X QUANG
ÑMP to daàn Khoù chaån ñoaùn phaân bieät
giöõa CIA vôùi RM+HVD.
CIA:Nhó (T) khoâng to,khoâng coù taùi
phaân phoái.
Veà sau,ÑMP to ôû trung taâm,nhoû ôû ngoaïi
vi (Tình traïng taêng aùp ÑMP laâu ngaøy
Thaønh tieåu ñoäng maïch daøy leân).

50
Tuần hoàn phổi bình thường Tái phân phối mạch máu phổi
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Dày vách liên tiểu thùy
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CARDIAC FAILURE
-Enlarged heart size.
-No clear heart border (interstitiel
edema), Kerley’s line, pleural effusion.
-Redistribution.
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X QUANG
-Left ventricle has normal size.
-Dilated upper lobe vessels.
-Bulging of the left atrial
appendage.
-Elevation of the left main
bronchus.
-Double contour of the right
heart border.
MITRAL STENOSIS

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X QUANG
-Small aortic knob.
-Bulging of the main pulmonary
artery.
appendage(large white arrow).
bronchus(black arrowheads).
-Double density through the heart
shadow(black arrows).
-Redistribution(small white arrows).
-The hilar vasculature is
prominent(white arrowhead).

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X QUANG
-Dilated upper lobe vessels.
-Bulging of the pulmonary
artery.
bronchus.
-Double contour of the right
heart border.

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X QUANG
-Left main bronchus is
displaced posteriorly by the
large left atrium.
-Large right ventricle touches
the sternum.
MITRAL STENOSIS

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X QUANG
PULMONARY ARTERIAL ANEURYSM /
SEVERE MITRAL STENOSIS

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X QUANG

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X QUANG

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X QUANG
THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-CAÁP
TÍNH
Phuø phoåi moâ keõ.
Phuø phoåi pheá nang.

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X QUANG
TÍNH
PULMONARY INTERSTITIAL EDEMA

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X QUANG
TÍNH
PULMONARY EDEMA

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X QUANG
THAY ÑOÅI VEÀ CHUÛ MOÂ PHOÅI-MAÏN TÍNH
ÔÛ ngöôøi Heïp van 2 laù laâu naêm, 1/3 giöõa
vaø 1/3 döôùi coù nhöõng ñoám Hemosiderine
do Hb thoaùt ra ngoaøi Hoàng caàu (1/3 döôùi
nhieàu hôn 1/3 giöõa).
Hemosiderine bò aên bôûi Ñaïi thöïc baøo
Hemosiderose.
Phaân bieät vôùiLao phoåi keâ:Noát keâ raûi khaép
phoåi (caû 3 phaàn treân,giöõa vaø döôùi phoåi).

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X QUANG
Xô phoåi:nhöõng daûi môø saéc neùt.
Daøy dính maøng phoåi:do thoaùt
dòch Daøy dính.
Nhöõng vuøng môø cuûa nhoài maùu phoåi
cuõ.

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X QUANG
Nhoài maùu phoåi (Pulmonary infarction) laø
moät bieán chöùng thöôøng gaëp cuûa beänh
van 2 laù vì thuyeân taéc coù nguoàn goác töø:
Hoaëc do nhöõng cuïc maùu ñoâng ôû ngoaïi
vi vì cung löôïng tim thaáp.
Hoaëc do cuïc maùu ñoâng töø Nhó (P) xuaát
hieän sau Rung nhó.

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X QUANG
-The cardiac silhouette is
typical of mitral stenosis.
-Consolidation and pleural
reaction at the left
base pulmonary infarction.

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X QUANG
HEMOSIDEROSIS IN MITRAL STENOSIS

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X QUANG
KERLEY’S B LINES & HEMOSIDEROSIS IN
MITRAL STENOSIS

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ÑAÏI CÖÔNG
HÔÛ VAN HAI LAÙ
(MITRAL REGURGITATION)
Hôû van 2 laù coù theå caáp tính:Ñöùt daây
chaèng-coät cô (sau Nhoài maùu cô tim,Vieâm
noäi taâm maïc nhieãm truøng) Hôû 2 laù
nhöng Thaát (T) chöa kòp giaõn roäng.
Hôû van 2 laù coù theå maïn tính:Sau RAA,
hoaëc do loã van giaõn roäng (Hoäi chöùng
Marfan, Beänh cô tim)…

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X QUANG
HÔÛ VAN HAI LAÙ NHEÏ
Thaát (T) vaø Nhó (T) giaõn lôùn do “overload”.
Nhó (T) coøn buø X quang tim-phoåi bình
thöôøng duø treân Laâm saøng nghe ATTT.
Do vaäy,cuõng nhö Heïp van 2 laù,X quang
tim-phoåi bình thöôøng khoâng loaïi tröø ñöôïc
Hôû van 2 laù.

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X QUANG
HÔÛ VAN HAI LAÙ TRUNG BÌNH
Nhó (T) coøn buø.
Nhó (T) to ra,nhöng aùp suaát chöa taêng
nhieàu.
Thaát (T) cuõng giaõn to vöøa phaûi.
Quai ÑMC nhoû do cung löôïng tim giaûm.

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X QUANG
HÔÛ VAN HAI LAÙ NAËNG
Nhó (T) maát buø.
Nhó (T) to ra,aùp suaát taêng cao.Neáu so
saùnh vôùi Heïp 2 laù ,thì Nhó (T) to hôn
nhieàu,coù khi vöôït ra ngoaøi bôø cuûa Nhó (P).
Thaát (T) to ra,taïo neân hình aûnh “big heart
disease”.
Treân hình nghieâng hoaëc LAO: Thaát (T) to
che laáp khoaûng saùng sau tim.

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X QUANG
Quai ÑMC nhoû do cung löôïng tim giaûm.
Phình cung ÑMP ”Mitralisation du bord
gauche du coeur”.
Taùi phaân phoái tuaàn hoaøn phoåi.
Caùc ñöôøng Kerley ít gaëp hôn vaø khoâng
roõ so vôùi Heïp van 2 laù.

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X QUANG
MITRAL REGURGITATION

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X QUANG
-Small aortic knob.
-Peribronchial cuffing due
to edema.
-Bulging of the pulmonary
artery.
-Left ventricular
enlargement.

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X QUANG

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X QUANG
-Straightening of the left heart border.
-Small aortic knob.
-Elevation of the left main bronchus.
-Bulging of the left atrial appendage.
-Huge left atrium.
-Enlargement of the cardiac silhouette.

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X QUANG
Enlarged left atrium.

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X QUANG
LATERAL VIEW:RETROGRADE
BRACHIAL ARTERY
CATHETERIZATION.
-Left ventricle (small arrows).
-Contrast through the
incompetent mitral valve into the
large left atrium (arrowheads).
-Filling of the pulmonary veins
(large arrows).

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X QUANG
-Small aortic knob.
bronchus.
-Enlargement of the left ventricle
and left atrium.
-The left atrium is calcified
(arrowheads).

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X QUANG
Calcification of the left atrial wall

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X QUANG
-Small aortic knob.
artery.
appendage.
-Extreme enlargement of the left
atrium.
-Enlargement of the cardiac
silhouette.
-Small right pleural effusion.

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X QUANG
Calcification of the posterior wall of
the huge left atrium.

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X QUANG
-Small aortic knob.
bronchus.
-Extreme enlargement of the
left atrium (arrows).
-Enlargement of the cardiac
silhouette.

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SIEÂU AÂM
HÔÛ VAN HAI LAÙ

87
PA view:Dilated left atrial
appendage (arrows).
Displacement of the left
ventricular contour
toward the left chest wall.
LAT view:Dilated left
atrium and ventricle.
MITRAL
REGURGITATION
RETROGRADE LEFT
VENTRICULOGRAM:
Dilated left atrium and
left atrial appendage
(arrows).
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X QUANG
CAÙC THEÅ KEÁT HÔÏP
Heïp+Hôû van 2 laù:Nhó (T) raát lôùn,coù ñoùng
voâi ôû van 2 laù vaø thaønh Nhó (T),tim to
toaøn boä.
Hôû van 2 laù+Beänh van ÑMC(Heïp,hôû).
Hôû van 2 laù+Hôû van 3 laù.
Hôû van 2 laù+Hôû van 3 laù+Beänh van
ÑMC.

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X QUANG

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X QUANG
Mitral valve stenosis
and regurgitation-
prosthetic mitral valve

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X QUANG
MITRAL STENOSIS AND
-Small aortic knob.
-Enlarged pulmonary artery(2).
-Enlarged left atrial appendage(3).
-Enlarged left ventricle(4).
-Double atrial contour(1).

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X QUANG
-Typical cardiac configuration of
mitral valvular disease.
-Calcification of the mitral valve
(black arrows).
-Calcific density in the left ventricle
(white arrows).
(Thrombus arose in the left atrium
Prolapsed into the left ventricle
Calcified thrombus).

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X QUANG
RAO
-Calcification of the mitral valve (black
arrows).
-Calcific density in the left ventricle (white
arrows).
MITRAL STENOSIS AND

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X QUANG
-Small aortic knob.
artery (white arrow).
-Enlargement of the left
ventricle (large arrowheads).
-Enlargement of the left atrium.
-Prominent of the superior
pulmonary veins (small
arrowhead).
-Kerley’s B lines.
MITRAL STENOSIS AND

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X QUANG
MITRAL STENOSIS AND MITRAL REGURGITATION

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X QUANG
bronchus (black arrow).
-Enlargement of the left
ventricle (arrowhead).
The aortic valvular lesions was not
suspected.It is often impossible to
diagnose the combined lesion on
plain films.
AND AORTIC REGURGITATION

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X QUANG
SEVERE MITRAL VALVE DISEASE

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ÑAÏI CÖÔNG
HEÏP VAN ÑOÄNG MAÏCH CHUÛ
(AORTIC STENOSIS)
Bình thöôøng SAO=2,5-3,5 cm2.
Khi SAO < 0,7cm2 Coù trieäu chöùng laâm
saøng.
Sinh lyù beänh:Heïp van ÑMC Taêng gaùnh
Thaát (T) Daøy ñoàng taâm Thaát (T).
Giaõn sau heïp ôû ÑMC leân,thaáy roõ treân
phim LAO.

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X QUANG
Bôø tim beân (T) baàu do daøy ñoàng taâm
Thaát (T),chæ soá T/N # 0,55.
ÑMC leân cong qua (P).
Quai ÑMC khoâng to vì löu löôïng ÑMC
giaûm.
Veà sau:
Moûm tim chuùc xuoáng do giaõn thaát (T).
Ñoùng voâi ôû van ÑMC (85%-sau RAA).

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X QUANG
Phoái hôïp:Heïp van ÑMC+Heïp van 2 laù.
ÔÛ ngöôøi treû,Heïp van ÑMC baåm sinh=
Van 2 maûnh (Bicuspid valve).
Chaån ñoaùn phaân bieät:
Cao huyeát aùp.
Xô vöõa ÑMC.

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X QUANG

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X QUANG
AORTIC STENOSIS

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X QUANG
AORTIC STENOSIS

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X QUANG
Calcifications in the heart lie
on a line drawn between the
sterno-diaphragmatic angle
and the carina.
CALCIFIED AORTIC VALVE

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X QUANG
Ascending aorta shows
slight post-stenotic
dilatation.

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X QUANG
-Aortic valve calcification (arrow).
-Posterior displacement of the left
ventricle behind the line of the
inferior vena cava.
AORTIC STENOSIS

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X QUANG
-Normal heart size.
-Dilated ascending aorta.

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X QUANG
Calcified aortic valve.
AORTIC STENOSIS

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X QUANG
-Rounded left heart border
(arrowheads).
-Dilated ascending aorta
(small arrows).
-The aortic knob is not enlarged.

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X QUANG
LAO
-Bulging of the ascending aorta
because of post-stenotic
dilatation (arrowheads).
-Calcified aortic valve (black
arrow).
AORTIC STENOSIS

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X QUANG

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X QUANG
AORTIC AND MITRAL STENOSIS

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COÄNG HÖÔÛNG TÖØ
GRADIENT-ECHO MR
-Aortic valve (arrow).
-The signal void in the
entire ascending aorta
due to marked
turbulence caused by
severe aortic stenosis.

6/19/2013 114
X QUANG
HÔÛ VAN ÑOÄNG MAÏCH CHUÛ
Nguyeân nhaân thöôøng gaëp nhaát laø sau
RAA.
Caùc nguyeân nhaân khaùc bao goàm:Giang
mai,Vieâm noäi taâm maïc nhieãm truøng,Hoäi
chöùng Marfan,Chaán thöông,ÑMC boùc
taùch,Vieâm khôùp daïng thaáp,Thoaùi hoùa
sau gheùp van sinh hoïc.

6/19/2013 115
X QUANG
Sinh lyù beänh:Maùu phuït ngöôïc vaøo Thaát
(T) trong kyø taâm tröông Giaõn buoàng
thaát (T).Thaát (T) giaõn Giaõn voøng van 2
laù Hôû van 2 laù Giaõn buoàng Nhó (T).
Moûm tim chuùc xuoáng döôùi vaø ra sau
Bôø (T) tim thoai thoaûi vaø ñænh tim ôû döôùi
voøm hoaønh (T).
Chæ soá T/N > 0,6.

6/19/2013 116
X QUANG
ÑMP khoâng to,coù khi nhö loõm vaøo.
ÑMC leân thöôøng khoâng giaõn,neáu ÑMC
leân giaõn roõ,phaûi coi chöøng coù keát hôïp
vôùi Heïp van ÑMC.
Quai ÑMC haàu nhö khoâng thay ñoåi.
Chieáu X quang:ÑMC ñaäp maïnh.

6/19/2013 117
X QUANG

6/19/2013 118
X QUANG
-Enlarged left ventricle.The apex
is displaced downward (large
arrow).
-The aorta is slightly prominent
but there is no post-stenotic
dilatation (small arrows).
AORTIC REGURGITATION

6/19/2013 119
X QUANG
-Enlarged left ventricle.
dilatation.

6/19/2013 120
X QUANG
-Enlarged left ventricle.
dilatation.

6/19/2013 121
X QUANG
-Dilated left ventricle.
-Post-stenotic dilatation of
the ascending aorta (arrow).

6/19/2013 122
X QUANG
-Calcified aortic valve (ring of
arrowheads).
-Posterior displacement of
the dilated left ventricle (row
of arrowheads) behind the
line of the inferior vena cava
(large arrow).
AORTIC STENOSIS & REGURGITATION

6/19/2013 123
X QUANG
RETROGRADE AORTOGRAM IN
Reflux flow (arrows) in the dilated
left ventricle.

6/19/2013 124
COÄNG HÖÔÛNG TÖØ
GRADIENT-ECHO MR
Regurgitant flow from the
aortic valve into the left
ventricle (arrow)

6/19/2013 125
ÑAÏI CÖÔNG
BEÄNH VAN ÑOÄNG MAÏCH PHOÅI MAÉC PHAÛI
(ACQUIRED PULMONARY VALVULAR LESIONS)
Beänh hieám khi ñôn ñoäc vaø hieám khi
naëng.
Beänh coù theå thaáy trong Hoäi chöùng
carcinoid.
Hình aûnh X quang thöôøng keát hôïp toån
thöông caùc van tim khaùc.

6/19/2013 126
ÑAÏI CÖÔNG
BEÄNH VAN BA LAÙ MAÉC PHAÛI
(ACQUIRED TRICUSPID LESIONS)
Töông ñoái gaëp nhieàu hôn beänh van
ÑMP maéc phaûi.
Beänh thöôøng gaëp nhaát sau RAA(Beänh
haàu nhö luoân luoân keát hôïp vôùi beänh lyù
van 2 laù vaø beänh lyù van ÑMC).
Caùc nguyeân nhaân khaùc:Vieâm noäi taâm
maïc nhieãm truøng,Chaán thöông
ngöïc,Böôùu carcinoid…

6/19/2013 127
X QUANG
Giaõn buoàng Thaát (P) vaø Nhó (P).
Thöôøng khoâng voâi hoùa van 3 laù.
Giaõn TMC treân,TM azygos.
Daáu hieäu phuï:Gan to,ñoäi voøm hoaønh (P)
leân cao.
Khi Hôû van 3 laù+Heïp van 2 laù Daáu taùi
phaân phoái vaø ñöôøng Kerley gaàn nhö
bieán maát.

6/19/2013 128
X QUANG
-Huge right atrium.
-Left lower lobe collapse
from compression by the
dilated heart (arrow).
TRICUSPID STENOSIS AND
REGURGITATION.
RIGHT HEART FAILURE.

6/19/2013 129
X QUANG
-Enlarged right atrium (large
arrows).
-Decrease in the pulmonary
vasculature.
-Small aortic knob.
-Typical left border of mitral valve
disease (small arrow).
-Elevation of the right hemi-
diaphragm.
TRICUSPID STENOSIS+AORTIC
STENOSIS+MITRAL STENOSIS

6/19/2013 130
ÖÙNG DUÏNG THÖÏC TEÁ

6/19/2013 131
KEÁT LUAÄN
Beänh van tim maéc phaûi phaàn lôùn do
RAA.
Toån thöông thöôøng gaëp nhaát ôû van 2 laù,
tieáp ñeán laø van ÑMC.
Coù theå chæ Heïp ñôn thuaàn,Hôû ñôn thuaàn,
coù theå Heïp-Hôû keát hôïp,coù theå toån thöông
nhieàu van cuøng moät luùc.

3.acquired valvular heart disease

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3.acquired valvular heart disease