-
and
Echocardiogram
（超声心动图）
1: PTCA
Case Study
9
-
（经皮冠状动脉内成形术）
,
old woman,
was admitted to the CCU with
chest pain,
dyspnea
（呼吸困难）
A.L., a 68
-
year
-
（舌
（恶心）
. She had
taken
three
sublingual
（
发汗）
,
syncope
（昏厥）
,and nauseadiapho
resis
（跨
-
minute
time spantablets
（片剂）
within a 10
下的）
doses of
nitroglycerine
（硝化甘油）
uptake
（摄取）
without
relief before dialing 911. A previous stress test
and thallium
（铊）
距）
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
endarterectomies
（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 bpm
（
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 catheterization
（
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
（
< br>支架放置
）
. Left ventricular f
unction
（
左心室功能
）
was
normal.
Echocardiogram
（
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 the 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。她的父亲死于急性心肌梗死的
62
岁。她母亲双侧颈动脉<
/p>
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<
/p>
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
< br>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 Report
A.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 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
（脱垂）
.
Extracorporeal
circulation
（体外循环）
was
established. The
aorta
（主动脉）
was cr
oss
-
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<
/p>
（间歇地）
for
myocardial protection
（心肌保护）
.
The left atrium
was entered via the interatrial
groove
（房间沟）
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 posterior 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 with
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）
.
Protamine
（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 discharged
（出院）
6 days later.
翻译：这是转移到营业厅，放置于仰卧位，
< br>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。<
/p>
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
-<
/p>
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）
in a Patient With
Asthma
（哮喘）
A.D., 15 years old, was seen in the
preadmission testing
（入院前检查，预进（气）试验
;
）
unit
（单位，基因，设备）
in
preparation for her elective spinal
（脊髓
的）
surgery
（外科手术）
.
She
has a history of mild
asthma since age 4, with at least one attack per
week. In an acute attack,
she will have mild
（轻微的）
dyspnea
（呼吸困难）
,
diffuse wheezing
（喘鸣）
, yet an
adequate
air exchange that
responds to
bronchodilators
（支气管扩张剂）
. She
was sent to pulmonary
health services for a
consult
（顾问医生）
with a specialist and pulmonary
function studies to
clear
her for surgery. The
anesthesiologist
（麻醉科医师）
reviewed the pulmonologist's report.
Her
prebronchodilator
（支气管收缩）
spirometry
（肺量测定法）
showed a mild
reduction
in vital capacity
but with a moderate to severe decrease in
FEV1
（一秒钟用力呼气量）
and
FEV1/FVC
（快速肺活量）
ratio
（比例）
. After
bronchodilator
（支气管扩张药）
administration
（给
药）
, there was a mild but insignificant
improvement in FEV1. The
postbronchodilator
（支气管的）
FEV1 was 55% of predicted and was
considered moderately
（适度的）
abnormal. The flow
volume loops
（流量循环）
and spirographic
curves
（呼吸描记曲线）
were
consistent with airflow
obstruction.
翻译：年，
15
岁，在她的脊柱手术术准备住院前的测试单元。从
4
岁开始
，她有轻度哮喘史，
每周至少有一次发作。
在急性发作时，
她会有轻度的呼吸困难、
弥漫性喘息，
但适
当的空气交换，
对支气管扩张剂。她被派到肺部健康服务，向一位专家咨询，并进行肺功
能检查，
以清除手术中
的她。麻醉师回顾专家的报告。
肺功能检查显示她的
prebronchodilator
肺活量轻微下降，但与中度至重度减少
FEV1
和
FEV1/FVC
< br>比值。支气管扩张药后，有一个轻微但显著改善
FEV1
。
55%
的
postbronchod
ilator
FEV1
预测被认为
是中度异常。流量循环和呼吸描记曲线与气流阻塞一致。
Case Study
11
-
2: Giant Cell Sarcoma of
the Lung
L.E., a 68
< br>-
year
-
old man,
was admitted to the pulmonary unit with chest pain
on inspiration,
dyspnea,
and diaphoresis. He had
smoked 11.2 packs of cigarettes per day for 52
years and had quit 3
months
ago.
L.E. was retired from
the advertising industry and admitted to
occasional alcohol use. He was
treated
for
primary giant cell sarcoma of the left lung 3
years ago with a lobectomy of the left lung
followed by
radiation and chemotherapy. Physical
examination was unremarkable except for a
thoracotomy
scar in the
left hemithorax, decreased breath sounds, and
dullness to percussion of the left base.
There was no hemoptysis.
Radionucleotide bone scan showed increased
activity in the left upper
posterior hemithorax. Chest and upper
abdomen CT scan showed .ndings compatible with
recurrent sarcoma of the
left hemithorax. Abnormal mediastinal nodes were
evident.
Thoracentesis was
attempted but did not yield .uid. L.E. was
scheduled for a left thoracoscopy,
mediastinoscopy, and biopsy.
Case Study 11
-
3:
Terminal Dyspnea
N.A., a 76
-
year
-
old woman, was in the ICU in the terminal stage of
multisystem organ failure. She
had
been
admitted to the hospital for bacterial pneumonia,
which had not resolved with antibiotic
therapy.
She had
a 20
-
year history of COPD.
She was not conscious and was unable to breathe on
her own.
Her
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