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心肌纤维之间有不定形的浅红色沉淀物,这是淀粉样蛋白的特征。淀粉样变性是引起“渗透性”或“限制性”心肌病的原因。如果这种病人在手术时发生难治性心律不齐,这是麻*醉师极不愿意看到的。

This section of myocardium demonstrates amorphous deposits of pale pink material between myocardial fibers. This is characteristic for amyloid. Amyloidosis is a cause for "infiltrative" or "restrictive" cardiomyopathy. It is a nightmare for anesthesiologists when intractable arrhythmias occur during surgery on such patients.

淀粉样变性心肌经刚果红染色。淀粉样物质经染色后应为橙红色,但是在偏振光下,淀粉样物质如图所示为“苹果绿”双折射。

A Congo red stain has been performed on the myocardium in a case of amyloidosis. The amyloid stains orange-red, but with polarized light, the amyloid has an "apple-green" birefringence as seen here.

虽然左心室变得很厚(厚度在2厘米以上),但是心脏的其它部分并没有相应地增大,这是高血压性心脏病的特点。高血压引起心脏的压力负荷增大,从而导致心肌肥大。

This left ventricle is very thickened (slightly over 2 cm in thickness), but the rest of the heart is not greatly enlarged. This is typical for hypertensive heart disease. The hypertension creates a greater pressure load on the heart to induce the hypertrophy.

严重的高血压,并且多年未经治疗,引起左心室显著地肥厚。心肌纤维已过度肥大。

The left ventricle is markedly thickened in this patient with severe hypertension that was untreated for many years. The myocardial fibers have undergone hypertrophy.

冠状动脉分支硬化,如图所示高血压时小动脉分支硬化,管腔明显狭窄。

The peripheral coronary arteries may undergo sclerosis, as seen here in an artery branch with a very small lumen, with chronic hypertension.

右心室、右心房剖开可见起搏器金属线,延伸并嵌入隔膜。起搏器辅助心律失常病人维持正常心律。

The right ventricle and atrium are opened to reveal a pacemaker wire that extends to the apex to embed on the septum. Pacemakers aid in maintaining a rhythm in hearts prone to arrhythmias.

图示离体猪人工生物瓣膜。左图显示心房面,右图显示心室面。可见三个瓣叶围绕形成环。人工生物瓣膜的优点是不需要连续抗凝治疗。此种生物瓣膜临床应用时病人平均寿命受限,一般为5-10年(也有可能更短),是由于瓣膜的磨损和钙化所致。

This is an excised porcine bioprosthesis; the undersurface is at the left and the outflow side is at the right. Note there are three cusps sewn into a synthetic ring. The main advantage of a bioprosthesis is the lack of need for continued anticoagulation. The drawback of this type of prosthetic heart valve is the limited lifespan, on average from 5 to 10 years (but sometimes shorter) because of wear and calcification.

图示机械瓣膜,通过瓣膜的倾斜来达到开关的目的。此种瓣膜寿命长,但病人需要连续抗凝治疗,因为暴露的非生物性瓣膜的表面。左侧为心房面,右侧为心室面。优点是能象正常瓣膜一样开关。

This is a mechanical valve prosthesis of the more modern tilting disk variety. Such mechanical prostheses will last indefinitely from a structural standpoint, but the patient requires continuing anticoagulation because of the exposed non-biologic surfaces. The superior aspect (here the left atrium) is seen at the left, while the outflow, with the two leaflets tilted outward toward the left ventricle, is at the right in this mitral valve prosthesis.

图示以前的球形笼式机械瓣膜,使用寿命长,但由于是非生物性的,因此需要连续抗凝治疗。左侧为心房面,右侧为心室面。优点是能象正常瓣膜一样开关。

人工瓣膜有以下并发症:
1、血栓形成
多见于机械瓣膜,需要病人进行持续抗凝治疗。
2、感染
感染后会在瓣膜周围形成赘生物,接着也会出现脓毒败血症。
3、结构破坏
主要见于生物瓣膜,瓣叶变硬、钙化。
4、人工瓣膜开裂
瓣膜与心脏的粘合处分离。
5、与心功能不协调
瓣膜可能与心脏不协调,血液流量没有达到最佳。

This is a mechanical valve prosthesis of the older ball and cage variety. Such mechanical prostheses will last indefinitely from a structural standpoint, but the patient requires continuing anticoagulation because of the exposed non-biologic surfaces. The superior aspect (here the left atrium) is seen at the left, while the outflow is at the right into the left ventricle in this mitral valve prosthesis.


A variety of problems can complicate prosthetic heart valves:

Thrombosis: this is a major potential problem with mechanical heart valves, requiring that the patient remain on anticoagulant therapy, though this will not entirely prevent thrombosis and subsequent embolization.

Infection: vegetations of infective endocarditis can develop on or around the prosthesis, and septic embolization can subsequently occur

Structural failure: this is a major problem with bioprostheses, because the leaflets tend to become stiff and calcify.

Dehiscence: seen mainly in the immediate postoperative period, dehiscence is separation of the prosthetic valve suture line from the heart, leading to paravalvular leakage

Disproportion: the prosthetic valve may not fit well in the heart, so that blood flow is not optimal.

通过X线可以看到较少见的瓣膜钙化环。多剖开的心脏可同看到白色的瓣膜钙化环。

A relatively benign and not too common condition that may show up on radiographic studies is mitral valve ring calcification. This produces a doughnut-shaped ring of calcification around the mitral valve annulus. The white circle here represents such a ring that has been sectioned as the heart was opened.


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