【胸部】心臟的大體及顯微鏡下觀課件

心臟的大體及顯微鏡下觀

正常心臟大體觀這是一個(gè)正常心臟的外形，心外膜看上去光滑而有光澤。心外膜脂肪的數(shù)量正常，左冠狀動(dòng)脈的前降支從主動(dòng)脈根部延伸到心尖部。正常主動(dòng)脈瓣大體觀

主動(dòng)脈瓣顯示三個(gè)薄而精密的瓣葉組織。其上可見冠狀動(dòng)脈的開口。心內(nèi)膜光滑，其下可見紅褐色的心肌組織。主動(dòng)脈瓣上的主動(dòng)脈壁顯示光滑的增生的內(nèi)膜組織，但無動(dòng)脈粥樣硬化的改變。正常三尖瓣大體觀這是三尖瓣結(jié)構(gòu)，瓣葉菲薄精密。和二尖瓣一樣，瓣葉邊緣也有細(xì)的腱索將其附著到下方室壁的乳頭肌上。正常心肌中倍顯微鏡下觀這是正常心肌纖維的縱軸觀，可見中心排列的細(xì)胞核及細(xì)胞之間沒有分界線，其中有些淺紅色的圓盤插入。正常冠狀動(dòng)脈顯微鏡下觀這是正常冠狀動(dòng)脈，具有很大，光滑，沒有阻塞的管腔，能為心肌提供充足的血液供應(yīng)。動(dòng)脈粥樣硬化性心血管疾病冠狀動(dòng)脈粥樣硬化性狹窄，顯微鏡下觀

冠狀動(dòng)脈顯示由於粥樣硬化斑塊的沉積導(dǎo)致官腔狹窄，嚴(yán)重的狹窄可導(dǎo)致心絞痛，心肌缺血和心肌梗塞（右下圖）。正常冠狀動(dòng)脈栓塞後再通，顯微鏡下觀

切面的冠狀動(dòng)脈顯示陳舊性的栓塞，並有再通而形成兩個(gè)小的狹窄通道。冠狀動(dòng)脈伴鈣化的粥樣硬化，顯微鏡下觀

這是冠狀動(dòng)脈嚴(yán)重狹窄的表現(xiàn)，它的複雜性在於其右下方有大片的鈣化區(qū)域，在蘇木素依紅染色上顯示藍(lán)色。複合性的動(dòng)脈粥樣硬化包括鈣化，血栓或出血。這些鈣化會使得冠狀動(dòng)脈成形很難成功。冠狀動(dòng)脈阻塞性粥樣硬化，顯微鏡下觀

冠狀動(dòng)脈的遠(yuǎn)端顯示明顯的狹窄，這種累及到末端的病變是嚴(yán)重動(dòng)脈粥樣硬化的典型改變。在伴有糖尿病和高脂血癥的病人，?？梢姷竭@種情況，會使搭橋手術(shù)十分困難。冠狀動(dòng)脈近期的栓塞，顯微鏡下觀在新近發(fā)生狹窄的冠狀動(dòng)脈中可見粉紅到紅色的新鮮血栓。其中開放的，針形的區(qū)域是粥樣硬化斑塊的膽固醇間隙。粥樣硬化斑塊，高倍顯微鏡下觀粥樣硬化改變的高倍鏡下觀，可見許多的泡沫細(xì)胞，及少許的膽固醇結(jié)晶，和散在的深藍(lán)色的炎性細(xì)胞。主動(dòng)脈伴有很少的脂質(zhì)紋，大體標(biāo)本這是基本正常的人體主動(dòng)脈的外觀，表面十分光滑，僅見少許菲薄的黃色脂質(zhì)條紋。主動(dòng)脈伴有脂肪條紋，大體標(biāo)本白色箭頭顯示的是主動(dòng)脈上最明顯的脂肪條紋，還有其他的散在於主動(dòng)脈的表面，脂肪條紋是動(dòng)脈粥樣硬化最早出現(xiàn)的改變。主動(dòng)脈不同程度的粥樣硬化改變，大體標(biāo)本

這三個(gè)主動(dòng)脈顯示的是輕，中，重度的動(dòng)脈粥樣硬化。最下面最輕的動(dòng)脈粥樣硬化僅顯示散在的脂質(zhì)斑塊；中間的顯示許多大的斑塊；最上面嚴(yán)重動(dòng)脈粥樣硬化病變顯示粥樣硬化上廣泛的潰瘍出現(xiàn)。主動(dòng)脈-粥樣硬化性主動(dòng)脈，大體標(biāo)本，CT片這裏是一個(gè)主動(dòng)脈粥樣硬化瘤的標(biāo)本，在腹主動(dòng)脈分叉處的上方形成球形的瘤體，但其體積增大到6-7釐米時(shí)，就很容易破裂。腹部CT顯示的是主動(dòng)脈瘤，體積接近6釐米，這時(shí)其很容易破裂。主動(dòng)脈粥樣硬化斑塊，低倍顯微鏡下觀顯微鏡下可見左側(cè)大的粥樣硬化斑塊，其中包含許多的膽固醇結(jié)晶。左側(cè)還可見潰瘍及出血。主動(dòng)脈粥樣硬化斑塊，高倍顯微鏡下觀

主動(dòng)脈粥樣硬化斑塊的高倍鏡下觀，可見泡沫細(xì)胞及膽固醇結(jié)晶主動(dòng)脈潰瘍性粥樣硬化併發(fā)附壁血栓，大體標(biāo)本這是嚴(yán)重粥樣硬化的主動(dòng)脈，已經(jīng)形成粥樣硬化斑塊的潰瘍及附壁血栓。腎臟的膽固醇栓子，中倍顯微鏡下觀冠狀動(dòng)脈中度粥樣硬化，大體標(biāo)本

一支冠狀動(dòng)脈縱形切開，周圍有心外膜脂肪，這裏心外膜的增加是全身脂肪增加的一部分。這裏的冠狀動(dòng)脈僅顯示輕度的粥樣硬化，可見散在的黃色脂質(zhì)斑塊而沒有狹窄。冠狀動(dòng)脈嚴(yán)重粥樣硬化，大體標(biāo)本這是從主動(dòng)脈根部左側(cè)發(fā)出的左冠狀動(dòng)脈，切開的為左前降支，有嚴(yán)重的粥樣硬化及廣泛的鈣化，末端有顯著的狹窄。冠狀動(dòng)脈粥樣硬化斑塊內(nèi)出血，大體標(biāo)本這是冠狀動(dòng)脈粥樣硬化合併出血到粥樣硬化斑塊內(nèi)，這種急性出血可能導(dǎo)致冠狀動(dòng)脈管腔狹窄。冠狀動(dòng)脈阻塞性粥樣硬化病變，大體標(biāo)本

冠狀動(dòng)脈的系列橫切面顯示管腔的狹窄，在左側(cè)的近端冠狀動(dòng)脈狹窄最嚴(yán)重，通常粥樣硬化病變在近端更為嚴(yán)重，那裏動(dòng)脈的血流速度很快。局灶性的病變越嚴(yán)重則PTCA或搭橋手術(shù)的效果更好。心臟及冠狀動(dòng)脈前降支最近的栓塞，大體標(biāo)本心臟前面切開的左前降支冠狀動(dòng)脈，在管腔內(nèi)可見新形成的深紅色的血栓。在前降支冠狀動(dòng)脈分佈的區(qū)域可見梗死的心肌。冠狀動(dòng)脈新的栓塞，縱形切開，大體標(biāo)本

在冠狀動(dòng)脈縱形切開面，可見冠狀動(dòng)脈管腔中深紅色的血栓。冠狀動(dòng)脈管腔中粥樣硬化斑塊使管腔顯著狹窄，而血栓形成則使管腔完全閉塞。心肌梗死心臟，左心室，急性心肌梗塞，大體標(biāo)本這裏左室縱形切開以顯示大範(fàn)圍的急性心肌梗死。壞死的中心是黃色的壞死肌肉，周圍是紅色的充血區(qū)，仍存活的心肌為紅褐色。心臟，左心室和室間隔，心肌梗塞，大體標(biāo)本Thiscrosssectionthroughtheheartdemonstratestheleftventricleontheleft.Extendingfromtheanteriorportionandintotheseptumisalargerecentmyocardialinfarction.Thecenteristanwithsurroundinghyperemia.Theinfarctionis"transmural"inthatitextendsthroughthefullthicknessofthewall.心肌，收縮帶壞死，顯微鏡下觀Theearliestchangehistologicallyseenwithacutemyocardialinfarctioninthefirstdayiscontractionbandnecrosis.Themyocardialfibersarebeginningtolosecrossstriationsandthenucleiarenotclearlyvisibleinmostofthecellsseenhere.Notethemanyirregulardarkerpinkwavycontractionbandsextendingacrossthefibers.心肌，急性心肌梗塞，1-2天，高倍顯微鏡下觀Thishighpowermicroscopicviewofthemyocardiumdemonstratesaninfarctionofabout1to2daysinduration.Themyocardialfibershavedarkredcontractionbandsextendingacrossthem.Themyocardialcellnucleihavealmostalldisappeared.Thereisbeginningacuteinflammation.Clinically,suchanacutemyocardialinfarctionismarkedbychangesintheelectrocardiogramandbyariseintheMBfractionofcreatinekinase.心肌，急性心肌梗塞，1-2天，顯微鏡下觀Inthismicroscopicviewofarecentmyocardialinfarction,thereisextensivehemorrhagealongwithmyocardialfibernecrosiswithcontractionbandsandlossofnuclei.心肌，急性心肌梗塞，3-4天，顯微鏡下觀Thismyocardialinfarctionisabout3to4daysold.Thereisanextensiveacuteinflammatorycellinfiltrateandthemyocardialfibersaresonecroticthattheoutlinesofthemareonlybarelyvisible.心肌，亞急性心肌梗塞，1-2周，顯微鏡下觀Thisisanintermediatemyocardialinfarctionof1to2weeksinage.Notethatthereareremainingnormalmyocardialfibersatthetop.Belowthesefibersaremanymacrophagesalongwithnumerouscapillariesandlittlecollagenization.心臟，透壁心肌梗塞伴破裂及血心包，大體標(biāo)本Onecomplicationofatransmuralmyocardialinfarctionisruptureofthemyocardium.Thisismostlikelytooccurinthefirstweekbetween3to5daysfollowingtheinitialevent,whenthemyocardiumisthesoftest.Thewhitearrowmarksthepointofruptureinthisanterior-inferiormyocardialinfarctionoftheleftventricularfreewallandseptum.Notethedarkredbloodclotformingthehemopericardium.Thehemo-pericardiumcanleadtotamponade.心臟，透壁心肌梗塞伴破裂，大體標(biāo)本Incrosssection,thepointofruptureofthemyocardiumisshownwiththearrow.Inthiscase,therewasapreviousmyocardialinfarction3weeksbefore,andanothermyocardialinfarctionoccurred,rupturingthroughthealreadythinventricularwall3dayslater.心臟，遠(yuǎn)期的心肌梗塞，中倍顯微鏡下觀Thereispalewhitecollagenwithintheinterstitiumbetweenmyocardialfibers.Thisrepresentsanareaofremoteinfarction.心臟，遠(yuǎn)期的心肌梗塞，低倍顯微鏡下觀Themyocardiumbeneaththeendocardialsurfaceatthetopdemonstratespalefibrosiswithcollagenizationfollowinghealingofasubendocardialmyocardialinfarction.心臟，遠(yuǎn)期的心肌梗塞，大體標(biāo)本Theheartisopenedtorevealtheleftventricularfreewallontherightandtheseptuminthecenter.Therehasbeenaremotemyocardialinfarctionthatextensivelyinvolvedtheanteriorleftventricularfreewallandseptum.Thewhiteappearanceoftheendocardialsurfaceindicatestheextensivescarring.心臟，左室室壁瘤，大體標(biāo)本Therehasbeenapreviousextensivetransmuralmyocardialinfarctioninvolvingthefreewalloftheleftventricle.Notethatthethicknessofthemyocardialwallisnormalsuperiorly,butinferiorlyisonlyathinfibrouswall.Theinfarctionwassoextensivethat,afterhealing,theventricularwallwasreplacedbyathinbandofcollagen,formingananeurysm.Suchananeurysmrepresentsnon-contractiletissuethatreducesstrokevolumeandstrainstheremainingmyocardium.Thestasisofbloodintheaneurysmpredisposestomuralthrombosis.心臟，左室室壁瘤，大體標(biāo)本Acrosssectionthroughtheheartrevealsaventricularaneurysmwithaverythinwallatthearrow.Notehowtheaneurysmbulgesout.Thestasisinthisaneurysmallowsmuralthrombus,whichispresenthere,toformwithintheaneurysm.心臟，冠狀動(dòng)脈搭橋移植血管，大體標(biāo)本Thispatientunderwentcoronaryarterybypassgraftingwithautogenousvein(saphenousvein)grafts.Thelargestoftheserunsdownthecenterofthehearttoanastomosewiththeleftanteriordescendingarterydistally.Anothergraftextendsina"Y"fashionjusttotherightofthistobranchesofthecircumflexartery.Awhitetemporarypacingwireextendsfromthemidleftsurface.動(dòng)脈剝脫主動(dòng)脈，弓部剝脫，大體標(biāo)本箭頭處為撕脫的部位,在主動(dòng)脈瓣上7cm。該病人的主動(dòng)脈瓣膜上及大血管近端有顯著的動(dòng)脈粥樣硬化改變。此例為主動(dòng)脈剝離。心臟，剝脫伴中膜撕裂，低倍顯微鏡下觀顯微鏡下觀，主動(dòng)脈上的撕裂處（箭頭部位）越過了內(nèi)膜，血流也沿著內(nèi)膜剝離（星形處）。血心包及心包填塞，大體標(biāo)本主動(dòng)脈剝離可以導(dǎo)致血心包，大量的出血會引起心包填塞主動(dòng)脈，剝脫，大體標(biāo)本主動(dòng)脈縱形切開，顯示很局限的主動(dòng)脈剝離。紅褐色的血栓位於主動(dòng)脈切面的兩側(cè)，包繞主動(dòng)脈。內(nèi)膜的撕裂處在左側(cè)，導(dǎo)致主動(dòng)脈形成雙腔。主動(dòng)脈，剝脫，顯微鏡下觀

剝離達(dá)到了動(dòng)脈的肌層。在任何情況下，主動(dòng)脈的剝離都是非常緊急的狀態(tài)，可以隨時(shí)導(dǎo)致死亡。血流可以沿著主動(dòng)脈的上下剝離主動(dòng)脈。沿著大血管的剝離可能導(dǎo)致頸動(dòng)脈的閉塞，有時(shí)也可以剝離到冠狀動(dòng)脈，並導(dǎo)致它們的閉塞。頸動(dòng)脈，剝脫伴壓迫主動(dòng)脈剝脫出血，導(dǎo)致頸動(dòng)脈的壓塞。血流也可以剝脫到冠狀動(dòng)脈。所以主動(dòng)脈剝脫的病人可以有嚴(yán)重的胸痛的癥狀（遠(yuǎn)端剝脫）或中風(fēng)的癥狀（頸動(dòng)脈剝脫）或心肌缺血的癥狀（冠狀動(dòng)脈剝脫）。主動(dòng)脈，剝脫，顯微鏡下觀顯微鏡下觀，顯示紅色的血栓壓迫主動(dòng)脈管腔。主動(dòng)脈，剝脫，Marfan氏綜合征，大體標(biāo)本這是在Marfan綜合癥的患者發(fā)生的主動(dòng)脈剝脫，剛好在主動(dòng)脈根部的上方。撕裂貫穿主動(dòng)脈，血心包及心包填塞在幾分鐘內(nèi)發(fā)生。二尖瓣脫垂，浮動(dòng)瓣膜，Marfan氏綜合征，大體標(biāo)本這還是在上例Marfan綜合癥患者，顯示的是二尖瓣。二尖瓣的瓣葉臃長，最左邊的而且向上球囊樣突起。這是典型的二尖瓣脫垂伴浮動(dòng)瓣葉。支持瓣葉的腱索變長變細(xì)。二尖瓣脫垂，浮動(dòng)瓣膜，Marfan氏綜合征，大體標(biāo)本ThisviewofthemitralvalveinapatientwithMarfan'ssyndromedepictsafloppymitralvalve.Theleafletonthelowerlefthasballoonedupwardandtheprolapsehasresultedincontusionofthetopoftheleaflet,witharedblackareaofdiscoloration.主動(dòng)脈，囊性中層壞死，Marfan氏綜合征，粘蛋白染色，蜘蛛樣指Marfan氏綜合征，大體ThehandattheleftisthatofayoungwomanwithMarfan'ssyndrome,whilethehandattherightisanormalmale.Bothpersonswereofthesameheight,188cm.However,notethatthehandattheleftdemonstratesarachnodactyly.

感染性心內(nèi)膜炎主動(dòng)脈瓣，感染性心內(nèi)膜炎，大體標(biāo)本Thisisinfectiveendocarditis.Theaorticvalvedemonstratesalarge,irregular,reddishtanvegetation.Virulentorganisms,suchasStaphylococcusaureus,producean"acute"bacterialendocarditis,whilesomeorganismssuchasStreptococcusviridansproducea"subacute"bacterialendocarditis.主動(dòng)脈瓣，感染性心內(nèi)膜炎，大體標(biāo)本Themorevirulentbacteriacausingtheacutebacterialformofinfectiveendocarditiscanleadtoseriousdestruction,asshownhereintheaorticvalve.Irregularreddishtanvegetationsoverlievalvecuspsthatarebeingdestroyed.Portionsofthevegetationcanbreakoffandbecomesepticemboli主動(dòng)脈瓣，感染性心內(nèi)膜炎，血管造影片Thisangiogramdemonstratestheaorticarchandgreatvessels.Anembolusfromacardiacvalvularvegetationfromtheleftsideoftheheartcantraveloutthesystemiccirculation.Shownhereisasepticembolusfrominfectiveendocarditistravellinguptheleftcommoncarotidartery,whichcouldresultinacerebralinfarctionand/orabscess.感染性心內(nèi)膜炎波及到心肌，大體標(biāo)本Inthiscase,theinfectiveendocarditisdemonstrateshowtheinfectiontendstospreadfromthevalvesurface.Here,vegetationscanbeseenontheendocardialsurfaces,andtheinfectionisextendingintotounderlyingmyocardium.二尖瓣，感染性心內(nèi)膜炎併發(fā)瘺管到右心，大體標(biāo)本Here,infectiveendocarditisonthemitralvalvehasspreadintotheseptumallthewaytothetricuspidvalve,producingafistula.感染性心內(nèi)膜炎，顯微鏡下觀Microscopically,thevalveininfectiveendocarditisdemonstratesfriablevegetationsoffibrinandplatelets(pink)mixedwithinflammatorycellsandbacterialcolonies(blue).Thefriabilityexplainshowportionsofthevegetationcanbreakoffandembolize.感染性心內(nèi)膜炎，顯微鏡下觀Hereisavalvewithinfectiveendocarditis.Thebluebacterialcoloniesonthelowerleftareextendingintothepinkconnectivetissueofthevalve.Valvesarerelativelyavascular,sohighdoseantibiotictherapyisneededtoeradicatetheinfection.

感染性心內(nèi)膜炎病人的甲下線形出血，大體感染性心內(nèi)膜炎病人的甲下線形出血，大體AnothersmalllinearsplinterhemorrhageisseenheresubunguallyontheleftthumbofapatientwithinfectiveendocarditisandbloodculturepositiveforStaphylococcusaureus.非感染性心內(nèi)膜炎非細(xì)菌性栓塞性心內(nèi)膜炎，大體標(biāo)本Thesmallpinkvegetationontherightmostcuspmarginrepresentsthetypicalfindingwithnon-bacterialthromboticendocarditis(orso-called"maranticendocarditis").Thisisnon-infective.Ittendstooccurinpersonswithahypercoagulablestate(Trousseau'ssyndrome,aparaneoplasticsyndromeassociatedwithmalignancies)andinveryillpersons.非細(xì)菌性栓塞性心內(nèi)膜炎，大體標(biāo)本Hereisanothermaranticvegetationontheleftmostcusp.Thesevegetationsarerarelyover0.5cminsize.However,theyareverypronetoembolize.非細(xì)菌性栓塞性心內(nèi)膜炎，顯微鏡鏡下觀Thevalveisseenontheleft,andablandvegetationisseenontheright.Itappearspinkbecauseitiscomposedoffibrinandplatelets.Itdisplaysaboutas

muchmorphologicvariationasabrownpaperbag.Suchblandvegetationsaretypicalofthenon-infectiveformsofendocarditis.Libman包囊心肌內(nèi)膜炎（二尖瓣風(fēng)濕性瓣膜炎）Hereareflat,paletan,spreadingvegetationsoverthemitralvalvesurfaceandevenonthechordaetendineae.Thispatienthassystemiclupuserythematosus.Thus,thesevegetationsthatcanbeonanyvalveorevenonendocardialsurfacesareconsistentwithLibman-Sacksendocarditis.Thesevegetationsappearinabout4%ofSLEpatientsandrarelycauseproblemsbecausetheyarenotlargeandrarelyembolize.Notealsothethickened,shortened,andfusedchordaetendineaethatrepresentremoterheumaticheartdisease.

二尖瓣，急性風(fēng)濕性贅生物，大體標(biāo)本Thesmallverrucousvegetationsseenalongtheclosurelineofthismitralvalveareassociatedwithacuterheumaticfever.Thesewartyvegetationsaverageonlyafewmillimetersandformalongthelineofvalveclosureoverareasofendocardialinflammation.Suchverrucaearetoosmalltocauseseriouscardiacproblems.二尖瓣，風(fēng)濕性狹窄，大體標(biāo)本Thehearthasbeensectionedtorevealthemitralvalveasseenfromaboveintheleftatrium.Themitralvalvedemonstratesthetypical"fishmouth"shapewithchronicrheumaticscarring.Mitralvalveismostoftenaffectedwithrheumaticheartdisease,

followedbymitralandaortictogether,thenaorticalone,thenmitral,aortic,andtricuspidtogether.心包炎嚴(yán)重的心包炎，圖解纖維性心包炎，圖解Thisdiagramdepictstheappearanceofafibrinouspericarditis.Thered-pinksquigglylinesextendingfromtheepicardialsurfaceintotheyellowfluidrepresentthestrandsoffibrin.Thistypeofpericarditisistypicalofuremiawithrenalfailure,underlyingmyocardialinfarction,andacuterheumaticcarditis.纖維性心包炎，大體標(biāo)本Awindowofadherentpericardiumhasbeenopenedtorevealthesurfaceoftheheart.Therearethinstrandsoffibrinousexudatethatextendfromtheepicardialsurfacetothepericarialsac.Thisistypicalforafibrinouspericarditis.纖維性心包炎，大體標(biāo)本Thisisanexampleofafibrinouspericarditis.Thesurfaceappearsroughenedfromthenormalglisteningappearancebythestrandsofpink-tanfibrin.

纖維性心包炎，大體標(biāo)本Theepicardialsurfaceoftheheartshowsashaggyfibrinousexudate.Thisisanotherexampleoffibrinouspericarditis.Thisappearancehasoftenbeencalleda"breadandbutter"pericarditis,butyouwouldhavetodropyourbutteredbreadonthecarpettoreallygetthiseffect.Thefibrinoftenresultsinthethefindingonphysicalexaminationofa"frictionrub"asthestrandsoffibrinonepicardiumandpericardiumrubagainsteachother.纖維性心包炎，顯微鏡下觀Microscopically,thepericardialsurfacehereshowsstrandsofpinkfibrinextendingoutward.Thereisunderlyinginflammation.Eventually,thefibrincanbeorganizedandcleared,thoughsometimesadhesionsmayremain.

出血性心包炎，大體標(biāo)本Thepericarditisherenotonlyhasfibrin,butalsohemorrhage.Thus,thisiscalleda"hemorrhagicpericarditis".Itisreallyjustfibrinouspericarditiswithhemorrhage.Withoutinflammation,bloodinthepericardialsacwouldbecalled"hemopericardium".

出血性心包炎，大體標(biāo)本Thesurfaceoftheheartwithhemorrhagicpericarditisdemonstratesaroughenedandredappearance.Hemorrhagicpericarditisismostlikelytooccurwithmetastatictumorandwithtuberculosis(TB).TBcanalsoleadtoagranulomatouspericarditisthatmaycalcifyandproducea"constrictive"pericarditis.心肌炎心臟，微膿腫，大體標(biāo)本Theepicardialsurfaceoftheheartissmoothandglistening,buttherearesmallscatteredpinpointyellowishmicroabscesses.(Highermagnificationinnextphoto).心臟，微膿腫，大體標(biāo)本Thismagnificationoftheprecedingphotographshowsthesmallyellowishpinpointmicroabscessesontheepicardialsurface.Microabscessesmayappearinpersonswhoareseptic.Theymayalsorepresentembolifromaninfectiveendocarditisinwhichsmallportionsofavegetationhaveembolizedoutthecoronaryarteries.

心臟，微膿腫，顯微鏡下觀Themicroscopicappearanceofamicroabscessisshownhere.Thecenterconsistsofbluebacterialcoloniesandissurroundedbyacuteinflammatorycells急性風(fēng)濕性心臟炎，顯微鏡下觀Microscopically,acuterheumaticcarditisismarkedbyapeculiarformofgranulomatousinflammationwithso-called"Aschoffnodules"seenbestinmyocardium.Thesearecenteredininterstitiumaroundvesselsasshownhere.Themyocarditismaybesevereenoughtocausecongestive

heartfailure.急性風(fēng)濕性心臟炎，顯微鏡下觀HereisanAschoffnoduleathighmagnification.ThemostcharacteristiccomponentistheAschoffgiantcell.Severalappearhereaslargecellswithtwoormorenucleithathaveprominentnucleoli.Scatteredinflammatorycellsaccompanythemandcanbemononuclearsoroccasionallyneutrophils.

急性風(fēng)濕性心臟炎，顯微鏡下觀AnotherpeculiarcellseenwithacuterheumaticcarditisistheAnitschkowmyocyte.Thisisalong,thincellwithanelongatednucleus.

慢性風(fēng)濕性瓣膜炎，大體標(biāo)本Intime,chronicrheumaticvalvulitismaydevelopbyorganizationoftheacuteendocardialinflammationalongwithfibrosis,asshownhereaffectingthemitralvalve.Notetheshortenedandthickenedchordaetendineae.間質(zhì)性濾過性毒菌性心肌炎，顯微鏡下觀Theinterstitiallymphocyticinfiltratesshownherearecharacteristicforaviralmyocarditis,whichisprobablythemostcommontypeofmyocarditis.Manyofthesecasesareprobablysubclinical.Somemaybeacauseforsuddendeathinyoungpersons.Thereisusuallylittlenecrosis.ThemostcommonviralagentisCoxsackieB.先天性心臟病常見先天性心臟病列表

先天性缺損的類型機(jī)制室間隔缺損(VSD)

是在室間隔的肌部或膜部存在一個(gè)缺損，引起左向右的分流，在缺損大的時(shí)候?qū)ρ鞯挠绊懞車?yán)重。房間隔缺損(ASD)

在房間隔的原發(fā)房間隔或繼發(fā)房間隔處存在一個(gè)缺損，引起中等的左向右分流。

動(dòng)脈導(dǎo)管未閉(PDA)

動(dòng)脈導(dǎo)管通常在出生後自動(dòng)閉合，如果不閉合就形成動(dòng)脈導(dǎo)管未閉，引起左向右分

法樂氏四聯(lián)癥TetralogyofFallot

肺動(dòng)脈狹窄引起右心室肥厚，右向左分流，騎跨於主動(dòng)脈之上的大的室間隔缺損。大動(dòng)脈轉(zhuǎn)位TranspositionofGreatVessels

主動(dòng)脈由右心室發(fā)出，肺動(dòng)脈由左心室發(fā)出。一個(gè)室間隔缺損或房間隔缺損，合併動(dòng)脈導(dǎo)管未閉，這是能夠存活的前提條件，病變屬於右向左分流。永存動(dòng)脈幹

TruncusArteriosus

在主動(dòng)脈與肺動(dòng)脈流出道處分隔不全，合併室間隔缺損，可以使氧合血與未氧合血混合，並引起右向左分流。左心發(fā)育不全HypoplasticLeftHeartSyndrome

主動(dòng)脈瓣膜和二尖瓣膜存在不同程度的發(fā)育不全或閉鎖，合併小的左室腔或者是完全缺如。主動(dòng)脈縮窄CoarctationofAorta

可以是在導(dǎo)管的近端(嬰兒型)或是在遠(yuǎn)端(成人型)，是主動(dòng)脈管腔的狹窄，導(dǎo)致流出道阻塞。完全性肺靜脈異位引流TotalAnomalousPulmonaryVenousReturn(TAPVR)

肺靜脈不是直接與左房相連接，而是回流到左無名靜脈，冠狀動(dòng)脈竇，或是其他部位，導(dǎo)致可能的血液混合，及右心的負(fù)荷過重。

大動(dòng)脈轉(zhuǎn)位TranspositionofGreatVessels

主動(dòng)脈由右心室發(fā)出，肺動(dòng)脈由左心室發(fā)出。一個(gè)室間隔缺損或房間隔缺損，合併動(dòng)脈導(dǎo)管未閉，這是能夠存活的前提條件，病變屬於右向左分流。永存動(dòng)脈幹

TruncusArteriosus

在主動(dòng)脈與肺動(dòng)脈流出道處分隔不全，合併室間隔缺損，可以使氧合血與未氧合血混合，並引起右向左分流。左心發(fā)育不全HypoplasticLeftHeartSyndrome

主動(dòng)脈瓣膜和二尖瓣膜存在不同程度的發(fā)育不全或閉鎖，並小的左室腔或者是完全缺如。主動(dòng)脈縮窄CoarctationofAorta

可以是在導(dǎo)管的近端(嬰兒型)或是在遠(yuǎn)端(成人型)，是主動(dòng)脈管腔的狹窄，導(dǎo)致流出道阻塞。完全性肺靜脈異位引流TotalAnomalousPulmonaryVenousReturn(TAPVR)

肺靜脈不是直接與左房相連接，而是回流到左無名靜脈，冠狀動(dòng)脈竇，或是其他部位，導(dǎo)致可能的血液混合，及右心的負(fù)荷過重。心臟，探查未閉的卵圓孔，及交叉性栓子，大體標(biāo)本右圖中是用一個(gè)金屬的探針檢查未閉的卵圓孔，正常時(shí)左房壓力使卵圓孔閉合，但當(dāng)肺動(dòng)脈高壓右房壓力顯著升高時(shí)（如肺動(dòng)脈栓塞），卵圓孔可能開放，並可能發(fā)生血栓經(jīng)過這裏進(jìn)入到左房，這種情況稱為交叉性栓子，因?yàn)槭窃陟o脈迴圈形成的栓子最後進(jìn)入了體循環(huán)。心臟，房間隔缺損，大體標(biāo)本在房間隔卵圓窩處有一個(gè)小的房間隔缺損，沒有被第二房間隔覆蓋，引起左向右分流。心臟，房間隔缺損，Eisenmenger氏綜合征這是一例大的房間隔缺損合併左向右分流，引起肺動(dòng)脈高壓，最終造成逆轉(zhuǎn)性的右向左分流，及顯著的右心室肥厚。這種由心間隔缺損造成的綜合癥稱為“Eisenmenger綜合癥”。圖左邊手指處是顯著增厚的三尖瓣下的右室遊離壁；右邊手指處為室間隔。心臟，室間隔缺損，大體觀這是一個(gè)死產(chǎn)嬰兒的未成熟的心臟，顯示的是膜部室間隔缺損，90%的室間隔缺損位於膜部，10%的位於肌部。心臟，房間隔缺損及室間隔缺損，大體觀這是一個(gè)合併房間隔缺損及肌部室間隔的心臟。心臟在左側(cè)切開，如此小的缺損不產(chǎn)生顯著的左向右分流，但確實(shí)可能增加發(fā)生感染性心內(nèi)膜炎的危險(xiǎn)。主動(dòng)脈縮窄之一，大體觀主動(dòng)脈縮窄的標(biāo)本，在縮窄後的主動(dòng)脈直徑僅有3mm。主動(dòng)脈縮窄之二，大體觀主動(dòng)脈延長軸切開來顯示主動(dòng)脈的縮窄，在狹窄的部位，由於血流的改變而更易導(dǎo)致動(dòng)脈粥樣硬化。肺動(dòng)脈瓣，四瓣化，大體觀這是一個(gè)不很常見的畸形（對病人也沒有顯著的意義），在這個(gè)肺動(dòng)脈瓣膜上有四個(gè)瓣葉。

主動(dòng)脈瓣的二瓣化，大體觀這裏是一個(gè)先天性的二瓣化主動(dòng)脈瓣膜，大多數(shù)二瓣化瓣膜容易發(fā)生鈣化。病人在長時(shí)間內(nèi)可以沒有癥狀，直到狹窄造成了充血性心力衰竭的迅速發(fā)生。白色的鈣化小結(jié)出現(xiàn)在瓣膜兩側(cè)，這裏切開的瓣膜位於左室流出道之上。主動(dòng)脈瓣，老年性鈣化導(dǎo)致主動(dòng)脈狹窄，大體觀主動(dòng)脈鈣化並不是總在二葉化的瓣膜上形成，在老年人正常的三葉瓣上，也可以形成主動(dòng)脈鈣化，稱為所謂的“老年性鈣化性主動(dòng)脈狹窄”，在左圖可見瓣葉上的鈣化點(diǎn)。心臟，法樂氏四聯(lián)征，圖解

此圖表現(xiàn)的是法樂氏四聯(lián)癥的特點(diǎn):1.室間隔缺損。2.主動(dòng)脈騎跨。3.肺動(dòng)脈狹窄。4.右心室肥厚。右心室流出道的阻塞引起了右向左的分流，並形成紫紺。心臟，永存動(dòng)脈幹，圖解圖表示的是永存動(dòng)脈幹，是由於主動(dòng)脈與肺動(dòng)脈之間的分隔不全所造成的，形成兩者之間在流出道部位沒有間隔。動(dòng)脈幹位於騎跨於兩個(gè)心室之上，永存動(dòng)脈幹通常合併有膜部室間隔缺損。

心臟，大動(dòng)脈轉(zhuǎn)位，圖解在左面的圖解中，顯示的是大動(dòng)脈的轉(zhuǎn)位。這是由於圓錐間隔沒有向下旋轉(zhuǎn)而是直接下降時(shí)發(fā)生的。因此右室流出道連接到主動(dòng)脈,而左室流出道連接到肺動(dòng)脈幹。通常會有合併的體循環(huán)與肺循環(huán)之間的交通，如室間隔缺損，房間隔缺損，在上圖中則是動(dòng)脈導(dǎo)管未閉。心肌病心肌病列表：

心肌

類型表現(xiàn)擴(kuò)張型(充血性)

所有四腔均擴(kuò)張，並肥厚。最常見的原因?yàn)榫凭卸荆渌部赡苁沁h(yuǎn)處病毒性心肌炎的晚期。肥厚型最常見的類型，原發(fā)性肥厚性主動(dòng)脈瓣下狹窄，由左室流出道阻塞不對稱的室間隔間肥厚引起。限制型心肌被侵潤造成心室的填充受損。最常見原因?yàn)樾募〉臐辗蹣幼冃院脱爻林?。心臟，擴(kuò)張性心肌病，大體Thisverylargehearthasagloboidshapebecauseallofthechambersaredilated.Itfeltveryflabby,andthemyocardiumwaspoorlycontractile.Thisisanexampleofacardiomyopathy.Thistermisusedtodenoteconditionsinwhichthemyocardiumfunctionspoorlyandtheheartislargeanddilated,butthereisnospec