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1、Case Study 9-1: PTCA （经皮冠状动脉内成形术）and Echocardiogram（超声心动图）A.L., a 68-year-old woman, was admitted to the CCU with chest pain, dyspnea（呼吸困难）, diaphoresis（发汗）, syncope（昏厥）,and nausea（恶心）. She had taken three sublingual（舌下的） doses of nitroglycerine（硝化甘油） tablets（片剂） within a 10-minute time span（跨距） wit
2、hout relief before dialing 911. A previous stress test and thallium（铊） uptake（摄取） scan suggested cardiac disease. Her family history was significant for cardiovascular disease（心血管疾病）. Her father died at the age of 62 of an acute myocardial infarction（急性心肌梗塞）. Her mother had bilateral carotid endarte
3、rectomies（双侧颈动脉内膜切除术）and a femoral-popliteal bypass（股腘动脉旁路术）procedure and died at the age of 72 of congestive heart failure（充血性心力衰竭）. A.L.s older sister died from a ruptured aortic aneurysm（主动脉动脉瘤破裂） at the age of 65. Her ECG（超声心动图） on admission（入院时） presented tachycardia（心跳过速） with a rate of 126 bp
4、m（每分钟心跳次数） with inverted T waves. A murmur（心脏杂音） was heard at S1（第一心音） . Her skin color was dusky to cyanotic（发紫的） on her lips and fingertips. Her admitting diagnosis（入院诊断） was possible coronary artery disease（冠心病）, acute myocardial infarction（急性心肌梗塞）, and valvular disease（心瓣膜病）. Cardiac catheteriza
5、tion（心导管术） with balloon angioplasty (PTCA) （经皮冠状动脉腔内成形术）was performed the next day. Significant（显著的） stenosis（狭窄） of the left anterior descending coronary artery （冠状动脉前降支）was shown and was treated with angioplasty（血管成形术 ） and stent placement（支架放置 ）. Left ventricular function（左心室功能） was normal. Echoc
6、ardiogram（超声心动图 ）, 2 days later, showed normal-sized left and enlarged right ventricular cavity. The mitral valve（二尖瓣） had normal amplitude of motion（正常运动幅度）. The anterior and posterior leaflets（小叶） moved in opposite directions during diastole（舒张期）. There was a late systolic（收缩期的） prolapse（脱出） of th
7、e mitral leaflet（二尖瓣瓣叶） at rest（静止）. The left atrium（左心房） was enlarged. The impression of the study was mitral prolapse（二尖瓣脱垂） with regurgitation（回流，反流）. Surgery was recommended.翻译：AL ，一个 68 岁的女子，被送往胸痛，呼吸困难，出汗，晕厥，恶心的 CCU。她需要三个舌下服用硝酸甘油片不到 10 分钟的时间跨度无缓解拨打 911 之前。先前压力测试和铊的吸收扫描表明心脏疾病。她的家族史对心血管疾病有重要意义。她的
8、父亲死于急性心肌梗死的 62 岁。她母亲双侧颈动脉内膜切除术和动脉旁路手术的股骨、享年 72 岁的充血性心力衰竭。这是姐姐死于主动脉瘤破裂 65 岁。她入院时的心电图出现心动过速 126 次/分的频率倒置 T 波。听到杂音在 S1。她的皮肤的颜色在她的嘴唇和指尖青紫暗。她承认诊断为冠心病、急性心肌梗死、心脏瓣膜病是可能的。球囊血管成形术（PTCA）心导管检查是下一天进行。左前降支冠状动脉的显着狭窄的显示，并与血管成形术和支架置入术。左室功能正常。超声心动图，2 天后，显示正常大小的左、右心室腔扩大。二尖瓣有正常的运动幅度。前部和后部的传单在相反的方向移动，在舒张期。在休息时，有一个晚期收缩期脱
9、垂的二尖瓣单张。左心房扩大。这项研究的印象是二尖瓣脱垂伴反流。手术推荐。Case Study 9-2: Mitral Valve Replacement Operative ReportA.L. was transferred（转移到） to the operating room（手术室）, placed in a supine position（仰卧位） , and given general endotracheal anesthesia（气管内麻醉）. Her pericardium（心包） was entered longitudinally（纵向） through a median
10、sternotomy（正中胸骨切开术）. The surgeon（外科医生） found that her heart was enlarged with a dilated（扩大的） right ventricle（右心室）. The left atrium（左心房） was dilated. Preoperative（手术前的） transesophageal （经食道的） echocardiogram（超声心动图） revealed severe mitral regurgitation （二尖瓣回流）with severe posterior and anterior prolapse
11、（脱垂）. Extracorporeal circulation（体外循环） was established. The aorta（主动脉） was cross-clamped（交叉夹紧）, and cardioplegic solution （交叉夹紧）(to stop the heartbeat) was given into the aortic root （主动脉根）intermittently （间歇地） for myocardial protection（心肌保护）. The left atrium was entered via the interatrial groove（房间
12、沟） on the right, exposing the mitral valve. The middle scallop（扇贝） of the posterior leaflet was resected. The remaining leaflets were removed to the areas of the commissures（连合） and preserved for the sliding（滑动的） plasty（成形术）. The elongated（展长） chordae （腱索）were shortened（缩短）. The surgeon slid the pos
13、terior leaflet across the midline and sutured it in place. A no.30 annuloplasty（瓣膜成形术） ring（环） was sutured in place with interrupted（间断的，阻断的） no.2-0（编号） Dacron suture（涤纶缝线）. The valve was tested by inflating（使充气） the ventricle with NSS and proved to be competent（有活性的）. The left atrium was closed wit
14、h continuous no.4-0 Prolene suture（聚丙烯缝线）. Air was removed from the heart. The cross-clamp （横跨钳闭）was removed. Cardiac action resumed with normal sinus rhythm（正常窦性心律）. After a period of cardiac recovery and attainment （达到）of normothermia（正常体温）, cardiopulmonary bypass（心肺分流术） was discontinued（不连续的）. Pr
15、otamine（鱼精蛋白） was given to counteract（抵抗,解(毒), 中和） the heparin（肝素钠,肝素）. Pacer（起搏器） wires were placed in the right atrium and ventricle. Silicone catheters were placed in the pleural and substernal spaces. The sternum（胸骨） and soft tissue wound was closed. A.L. recovered from her surgery and was disch
16、arged（出院） 6 days later.翻译：这是转移到营业厅，放置于仰卧位，并给予气管插管全麻。她的包进入纵向通过胸骨正中切口。外科医生发现她的心脏扩大了扩张的右心室。左心房扩张。术前经食管超声心动图显示严重的前、后脱垂二尖瓣重度关闭不全。建立体外循环。主动脉交叉夹紧，和心脏停搏液（停止心跳）进行主动脉根部间断心肌保护。左心房是通过右边的房间沟进入，显露二尖瓣。经手术切除后小叶中孔扇贝。剩下的传单被拆除的连合的区域和保存滑动成形术。细长的腱索缩短。外科医生地滑过中线后叶缝合到位。30 瓣环缝合的地方，打断了 no.2-0 涤纶缝线。该阀是由 NSS 充气室测试并证明是主管。左心房是连续 no.4-0 聚丙烯缝线关闭。空气被从心脏取出。取十字钳。正常窦性心律恢复正常。一段时间的心脏复苏和实现常温体外循环停止后。鱼精蛋白中和肝素的了。起搏器导线放置在右心房和右心室。硅胶导管放置在胸腔和胸骨后间隙。胸骨和软组织创面封闭。这从她的手术 6 天后出院。Case Study 11-1: Preoperative（手术前） Testing（测验
