A47-year-oldmanpresentedtotheemergencydepartmentwitha6-monthhistoryofworseningexertionaldyspnea.HehadrecentlyemigratedfromHondurasandhadahistoryofcardiacsurgeryasachild,buttheinitialdiagnosisandspecificprocedurethathadbeenperformedwerenotknown.Thephysicalexaminationrevealedarightparasternalheave,aloudS1,amidpeakingsystolicejectionmurmur(grade2/6)attheuppersternalborder,andalow-pitcheddiastolicrumbleattheapex.Anelectrocardiogramshowedatrialflutterwithvariableatrioventricularconduction.Transthoracicechocardiographyrevealedmoderateaorticstenosis(calculatedvalvearea,1.3cm2)andveryseveremitralstenosis(calculatedvalvearea,0.5cm2)(seevideoandPanelA;LAdenotesleftatrium,LVleftventricle,andMVmitralvalve).Theleftatriumwasenlarged,withanindexedatrialvolumeofmlpersquaremeter(normalvalue,35).Color-flowDopplerimages(PanelB,upperhalf)andacontinuous-waveDopplerflowpattern(PanelB,lowerhalf)showedthestenoticmitralvalveduringdiastole.Thecontinuous-waveDopplerflowpatterndepictsflowvelocity(verticalaxis)andtime(horizontalaxis).Theslowdeclineintransmitralflowvelocityreflectstheveryslowdecreaseinleftatrialpressureandslowincreaseinleftventriculardiastolicpressurethatoccurinmitralstenosis.Themeantransmitralgradientwas14mmHg(normalvalue,3).Thepatientunderwentreplacementofthemitralandaorticvalveswithmechanicalprostheses.Ata6-monthfollow-upvisit,hehadonlyslightlimitationsonphysicalactivity(NewYorkHeartAssociationclassII).
一名47岁男子因急性劳累性呼吸困难病史6个月被送往急诊室。他最近从洪都拉斯移民并且从小就有过心脏手术的历史，但最初的诊断和已经进行的具体手术尚不清楚。身体检查显示右侧胸骨旁隆起，闻及S1，上胸骨边缘的中早期收缩期射血杂音（2/6级），以及心尖处的低音舒张隆隆声。心电图显示心房扑动，具有可变的房室传导。经胸超声心动图显示中度主动脉瓣狭窄（计算瓣膜面积，1.3cm2）和非常严重的二尖瓣狭窄（计算的瓣膜面积，0.5cm2）（见视频和A组;LA表示左心房，LV左心室和MV二尖瓣）。左心房扩大，心房容积指数为每平方米毫升（正常值，35）。彩色血流多普勒图像（图B，上半部分）和连续波多普勒血流模式（图B，下半部分）显示舒张期间的狭窄二尖瓣。连续波多普勒流动模式描绘了流速（垂直轴）和时间（水平轴）。传递流速的缓慢下降反映了左心房压力的非常缓慢的减少和二尖瓣狭窄中发生的左心室舒张压的缓慢增加。平均透射梯度为14mmHg（正常值，3）。患者用机械假体更换二尖瓣和主动脉瓣。在为期6个月的随访中，他对身体活动只有轻微的限制（纽约心功能分级II级）。
emigrate移民
reveale揭示
ventricular心室
atrium心房
