Feldman T
University of Chicago, Division of the Biological Sciences, Pritzker School of Medicine.
Postgrad Med. 1993 May 1;93(6):93-4, 99-104. doi: 10.1080/00325481.1993.11701686.
Rheumatic mitral stenosis remains an important cause of exertional dyspnea, pulmonary congestion, atrial fibrillation, and stroke. Detection rests on careful auscultatory examination and detailed review of chest films. Diagnosis is confirmed by echocardiographic examination; cardiac catheterization is important in symptomatic patients to evaluate the severity of stenosis and associated lesions. Treatment of pulmonary congestion and control of heart rate in patients with atrial fibrillation remain major medical goals. Percutaneous balloon commissurotomy is preferred for most patients with predominant mitral stenosis and for those with contraindications to valve replacement. Implantation of a prosthetic valve is best for patients with significant mitral regurgitation, multivalve disease, associated coronary artery disease that requires bypass, or mitral valve deformity too severe to allow adequate balloon commissurotomy.
风湿性二尖瓣狭窄仍然是劳力性呼吸困难、肺淤血、心房颤动和中风的重要病因。诊断依赖于仔细的听诊检查和胸部X线片的详细评估。超声心动图检查可确诊；对于有症状的患者，心导管检查对于评估狭窄的严重程度和相关病变很重要。治疗肺淤血和控制心房颤动患者的心率仍然是主要的医学目标。对于大多数以二尖瓣狭窄为主的患者以及有瓣膜置换禁忌证的患者，经皮球囊二尖瓣交界切开术是首选。对于有严重二尖瓣反流、多瓣膜病、需要搭桥的相关冠状动脉疾病或二尖瓣畸形严重到无法进行充分球囊交界切开术的患者，植入人工瓣膜是最佳选择。
