MioAtlas
G1: 左心系统瓣膜

钙化性主动脉瓣狭窄

老年退行性主动脉瓣狭窄，其特征是主动脉瓣三瓣叶发生进行性纤维粥样硬化性钙化，从瓣叶根部开始向游离边缘进展，且无瓣交界处融合。

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定义

老年退行性主动脉瓣狭窄，其特征是主动脉瓣三瓣叶发生进行性纤维粥样硬化性钙化，从瓣叶根部开始向游离边缘进展，且无瓣交界处融合，从而限制收缩期瓣口开放并增加左心室后负荷 [V1] [V4]。

严重程度标准

  • 轻度（L）：经主动脉瓣峰值流速（Vmax）2.6–2.9 m/s；经主动脉瓣平均跨瓣压差 < 20 mmHg；主动脉瓣口面积（AVA）> 1.5 cm²；流速比（Vratio）> 0.50 [V1] [V4]。
  • 中度（M）：Vmax 3.0–3.9 m/s；平均跨瓣压差 20–39 mmHg；AVA 1.0–1.5 cm²；Vratio 0.25–0.50 [V1] [V4]。
  • 重度（G）：Vmax ≥ 4.0 m/s；平均跨瓣压差 ≥ 40 mmHg；AVA < 1.0 cm²（或指数化AVA < 0.6 cm²/m²）；Vratio < 0.25 [V1] [V4]。

分层表现

血流动力学

  • 主动脉瓣平均跨瓣压差：L < 20 mmHg，M 20–39 mmHg，G ≥ 40 mmHg [V1] [V4]。
  • 主动脉瓣峰值流速：L 2.6–2.9 m/s，M 3.0–3.9 m/s，G ≥ 4.0 m/s [V1] [V4]。
  • 体循环动脉血压：重度阶段脉压变窄伴收缩期上升延迟 [B4] [V1]。

心律

  • 正常窦性心律 [V1]。
  • 晚期阶段或钙化累及房室结时：可能出现心房颤动或传导障碍 [E2] [V1]。

ECG

  • 收缩期压力负荷过重引起的向心性左心室肥厚（左心室肥厚电压标准，Sokolow-Lyon / Cornell标准阳性，侧壁导联伴ST段压低和不对称T波倒置）[E1] [V1]。

心音与杂音

  • 收缩期杂音：胸骨右缘第2肋间（主动脉瓣区）可闻及粗糙、响亮的喷射性收缩中期杂音（渐强-渐弱型），典型向颈动脉传导 [G1-14] [V4]。
  • Gallavardin现象：老年患者中的声学分离现象，杂音的高频成分在心尖部听诊呈纯净的乐鸣样，酷似二尖瓣关闭不全 [G1-14]。
  • 第二心音（S2）：在重度表现中由于瓣叶极度钙化僵硬，主动脉瓣成分（A2）减弱、柔和或消失；可能出现S2反常分裂 [G1-11] [V4]。
  • 第四心音（S4）：在窦性心律下常见，由心房收缩对抗顺应性减退的肥厚心室所致 [G1-13]。

动脉脉搏

  • 重度表现中：脉搏上升缓慢且达峰延迟（迟脉与细脉 / 升抬脉）[B4] [V1]。

颈静脉搏动

  • 通常正常；若室间隔肥厚降低右室顺应性（Bernheim效应），可出现明显的“a”波 [B3]。

负荷试验

  • Valsalva动作（用力相）：显著减弱杂音强度 [B1]。
  • 下蹲位：通过增加静脉回流和每搏输出量使杂音强度增强 [B1]。
  • 突然站立：通过减少前负荷使杂音减弱 [B1]。
  • 等长握力试验：使杂音强度维持不变或轻度减弱 [B1]。

模拟器严重程度分级

模拟器严重程度分级: 轻度, 中度, 重度
基线心律: 正常窦性心律

亦称为： 老年性主动脉瓣狭窄 · 退行性主动脉瓣狭窄 · 钙化性主动脉瓣狭窄 · 主动脉瓣狭窄 · AS

该组中的其他病变

相关临床对比

文献来源

  1. [B1] Bedside diagnosis of systolic murmurs . N Engl J Med (1988) . DOI: 10.1056/NEJM198806163182404 PubMed: 2897627
  2. [B3] The jugular venous pressure revisited . Cleve Clin J Med (2013) . DOI: 10.3949/ccjm.80a.13039 PubMed: 24085809
  3. [B4] The Carotid Pulse . Clinical Methods: The History, Physical, and Laboratory Examinations (1990) . PubMed: 21250154
  4. [E1] AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part V: electrocardiogram changes associated with cardiac chamber hypertrophy: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: endorsed by the International Society for Computerized Electrocardiology . Circulation (2009) . DOI: 10.1161/CIRCULATIONAHA.108.191097 PubMed: 19228820
  5. [E2] AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III: intraventricular conduction disturbances: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: endorsed by the International Society for Computerized Electrocardiology . Circulation (2009) . DOI: 10.1161/CIRCULATIONAHA.108.191095 PubMed: 19228822
  6. [G1-01] Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice . J Am Soc Echocardiogr (2009) . DOI: 10.1016/j.echo.2008.11.029 PubMed: 19130998
  7. [G1-11] The Second Heart Sound . Clinical Methods: The History, Physical, and Laboratory Examinations (1990) . PubMed: 21250183
  8. [G1-13] The Fourth Heart Sound . Clinical Methods: The History, Physical, and Laboratory Examinations (1990) . PubMed: 21250185
  9. [G1-14] Systolic Murmurs . Clinical Methods: The History, Physical, and Laboratory Examinations (1990) . PubMed: 21250186
  10. [V1] 2025 ESC/EACTS Guidelines for the management of valvular heart disease . Eur Heart J (2025) . DOI: 10.1093/eurheartj/ehaf194 PubMed: 40878295
  11. [V2] 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines . Circulation (2021) . DOI: 10.1161/CIR.0000000000000923 PubMed: 33332150
  12. [V4] Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography . Eur Heart J Cardiovasc Imaging (2017) . DOI: 10.1093/ehjci/jew335 PubMed: 28363204