对疑似严重主动脉瓣狭窄进行血流动力学评估后诊断为肾细胞癌。
Hemodynamic evaluation of suspected severe aortic stenosis leads to a diagnosis of renal cell carcinoma.
作者信息
Lake Mikhailia, Tanawuttiwat Tanyanan, Bilsker Martin, De Marchena Eduardo
出版信息
Tex Heart Inst J. 2015 Feb 1;42(1):77-9. doi: 10.14503/THIJ-13-3925. eCollection 2015 Feb.
Abstract
The evaluation of aortic stenosis is not always straightforward. When symptoms of severe aortic stenosis are present with supporting Doppler echocardiographic or cardiac catheterization data, replacement of the aortic valve is recommended. Occasionally, Doppler- and catheter-derived data are discordant; appropriate treatment in such cases becomes less clear. We report a case in which a 66-year-old man's symptoms and Doppler data suggested severe aortic stenosis. However, heart catheterization data suggested otherwise, and ultimately it led to the diagnosis of a highly vascular renal tumor. Shunting within the tumor resulted in high cardiac output, which, in combination with a small aortic root, masqueraded as severe aortic stenosis.
摘要
主动脉瓣狭窄的评估并非总是简单直接。当出现严重主动脉瓣狭窄的症状并伴有支持性的多普勒超声心动图或心导管检查数据时，建议进行主动脉瓣置换。偶尔，多普勒和心导管检查得出的数据不一致；在这种情况下，合适的治疗方法就不那么明确了。我们报告一例病例，一名66岁男性的症状和多普勒数据提示严重主动脉瓣狭窄。然而，心导管检查数据却显示并非如此，最终诊断为高度血管化的肾肿瘤。肿瘤内的分流导致高心输出量，再加上主动脉根部较小，伪装成严重主动脉瓣狭窄。
相似文献
1
Hemodynamic evaluation of suspected severe aortic stenosis leads to a diagnosis of renal cell carcinoma.对疑似严重主动脉瓣狭窄进行血流动力学评估后诊断为肾细胞癌。
Tex Heart Inst J. 2015 Feb 1;42(1):77-9. doi: 10.14503/THIJ-13-3925. eCollection 2015 Feb.
2
Understanding the catheter-Doppler pressure gradient discrepancy in aortic stenosis.理解主动脉瓣狭窄中导管-多普勒压力阶差差异
J Heart Valve Dis. 2011 May;20(3):299-300.
3
4
How should I treat a patient with a stenosed bicuspid aortic valve and an unexpected finding during TAVI?对于患有二叶式主动脉瓣狭窄且在经导管主动脉瓣置入术（TAVI）期间有意外发现的患者，我该如何治疗？
EuroIntervention. 2014;9(12):1474-7. doi: 10.4244/EIJV9I12A246.
5
6
Implementing a Continuous Quality Improvement Program in a High-Volume Clinical Echocardiography Laboratory: Improving Care for Patients With Aortic Stenosis.在高容量临床超声心动图实验室实施持续质量改进计划：改善主动脉瓣狭窄患者的护理
Circ Cardiovasc Imaging. 2016 Mar;9(3). doi: 10.1161/CIRCIMAGING.115.003708.
7
Doppler derived aortic valve resistance in aortic stenosis: its hemodynamic validation.多普勒测量的主动脉瓣狭窄时的主动脉瓣阻力：其血流动力学验证
J Heart Valve Dis. 1994 May;3(3):283-7.
8
Determination of severity of valvular aortic stenosis by Doppler echocardiography and relation of findings to clinical outcome and agreement with hemodynamic measurements determined at cardiac catheterization.通过多普勒超声心动图测定主动脉瓣狭窄的严重程度及其结果与临床结局的关系，以及与心导管检查测定的血流动力学测量结果的一致性。
Am J Cardiol. 1991 May 1;67(11):1007-12. doi: 10.1016/0002-9149(91)90175-k.
9
Effect of Doppler echocardiography on utilization of hemodynamic cardiac catheterization in the preoperative evaluation of aortic stenosis.多普勒超声心动图对主动脉瓣狭窄术前评估中血流动力学心脏导管检查应用的影响。
Mayo Clin Proc. 1996 Feb;71(2):141-9. doi: 10.4065/71.2.141.
10
[Preoperative evaluation of severe aortic stenosis by Doppler echocardiography and hemodynamics].[通过多普勒超声心动图和血流动力学对重度主动脉瓣狭窄进行术前评估]
Arch Inst Cardiol Mex. 1998 Jan-Feb;68(1):58-63.
本文引用的文献
1
Improving assessment of aortic stenosis.改善主动脉瓣狭窄的评估。
J Am Coll Cardiol. 2012 Jul 17;60(3):169-80. doi: 10.1016/j.jacc.2011.11.078.
2
Percutaneous transarterial aortic valve implantation: what do we know?经皮经导管主动脉瓣植入术：我们了解多少？
Eur Heart J. 2011 Jan;32(2):140-7. doi: 10.1093/eurheartj/ehq453. Epub 2010 Dec 4.
3
ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons.美国心脏病学会/美国心脏协会瓣膜性心脏病患者管理指南（2006年）：美国心脏病学会/美国心脏协会实践指南工作组（修订1998年瓣膜性心脏病患者管理指南的写作委员会）报告：与心血管麻醉医师协会合作制定：得到心血管造影和介入学会及胸外科医师协会认可。
Circulation. 2006 Aug 1;114(5):e84-231. doi: 10.1161/CIRCULATIONAHA.106.176857.
4
Spectrum of calcific aortic valve disease: pathogenesis, disease progression, and treatment strategies.钙化性主动脉瓣疾病的谱系：发病机制、疾病进展及治疗策略。
Circulation. 2005 Jun 21;111(24):3316-26. doi: 10.1161/CIRCULATIONAHA.104.486738.
5
Discrepancies between catheter and Doppler estimates of valve effective orifice area can be predicted from the pressure recovery phenomenon: practical implications with regard to quantification of aortic stenosis severity.导管测量与多普勒测量的瓣膜有效瓣口面积之间的差异可通过压力恢复现象进行预测：对主动脉瓣狭窄严重程度量化的实际意义。
J Am Coll Cardiol. 2003 Feb 5;41(3):435-42. doi: 10.1016/s0735-1097(02)02764-x.
6
"Overestimation" of catheter gradients by Doppler ultrasound in patients with aortic stenosis: a predictable manifestation of pressure recovery.主动脉瓣狭窄患者中，多普勒超声对导管梯度的“高估”：压力恢复的可预测表现
J Am Coll Cardiol. 1999 May;33(6):1655-61. doi: 10.1016/s0735-1097(99)00066-2.
7
Natural history of aortic valve stenosis of varying severity in the elderly.老年人不同严重程度主动脉瓣狭窄的自然病史。
Am J Cardiol. 1996 Jul 1;78(1):97-101. doi: 10.1016/s0002-9149(96)00235-4.
8
Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample.老年人主动脉瓣异常的患病率：一项随机人群样本的超声心动图研究
J Am Coll Cardiol. 1993 Apr;21(5):1220-5. doi: 10.1016/0735-1097(93)90249-z.
9
Flow dependence of measures of aortic stenosis severity during exercise.运动期间主动脉瓣狭窄严重程度测量的血流依赖性
J Am Coll Cardiol. 1994 Nov 1;24(5):1342-50. doi: 10.1016/0735-1097(94)90118-x.
10
Determination of the stenotic aortic valve area in adults using Doppler echocardiography.使用多普勒超声心动图测定成人主动脉瓣狭窄面积
J Am Coll Cardiol. 1986 Mar;7(3):509-17. doi: 10.1016/s0735-1097(86)80460-0.
Zotero 插件