心脏瓣膜病19.pptVIP

Atrial fibrillation Infective endocarditis Embolism Heart failure Complication Prognosis 急性严重返流者，若不及时手术，极难存活 慢性MI无症状期长，一旦发生左心衰竭，预后不良 Therapy Medical therapy (内科治疗) Prevent endocarditis and rheumatic fever Patients who are asymptomatic and having normal cardiac function needn’t therapy but regular follow-up (定期随访). Complication are cured in patients with complication. Surgical treatment Prosthetic valve replacement 为主要手术方法，趋向早期手术 有症状者应在LVEF＜0.5，平均肺动脉压 ＞20mmHg之前手术 产生左室功能不全、LVEF 0.3－0.5、年龄＞55岁、 LVEDD≥80mm，已不置换瓣 Valvuloplasty of mitral valve (二尖瓣整复术) 优点：不需长期抗凝，LV功能恢复较好 Aortic Valve Disease 主动脉瓣疾病 Aortic stenosis (AS) 主动脉瓣狭窄 Etiology and Pathology Rheumatic heart disease ：风湿性炎症所致瓣膜交界处融合、瓣叶纤维化、钙化，引起瓣叶狭窄畸形，多伴AI及二尖瓣损害 Congenital bicuspid valve (先天性二叶瓣) Senile calcific (degenerative) AS (退行性老年钙化性主动脉瓣狭窄)：65岁老年人AS的常见原因，瓣叶主动脉面钙化结节限制瓣叶活动 Pathophysiology The cross-sectional area of the aortic valve orifice (瓣环口面积） Normal adult ≥3.0cm2 The area ≤1.0cm2,LVSP↑,transvalve pressure gradient manifest (跨瓣压差明显) AS→After loading↑→LV hypertrophy→LVEDP↑ LA amplification ↓ PAP PCP↑ ↓ Lung congestion and edema Myocardial ischemia 　 ↓ Myocardial contractility↓ ↓ Heart failure Clinical situation Symptom AS Triple syndrom (AS三联症)　 Dyspnoea (呼吸困难): Lung congestion Angina (心绞痛) Causing by Synocope (晕厥) cardiac output↓ Clinical situation Physical sign Cardiac sound:S1 is normal ,S2 is paradoxical splitting(逆分裂), S4 may be heard Cardiac murmur:：SM is heard on the second intercostal space(肋间)of right border of sternum , and radiate to cervical part (颈部), left inferior border of sternum and cardiac apex accompanying thrill Cardiac dilatation(心脏扩大)，SBP and pulse pressure decrease Laboratory examination X-Ray：心影可正常或稍大，晚期见肺淤血 ECG：可有左室肥厚劳累征，及各种心律失常 Echocardiogram：为确定、定量AS的重要方法 Cardiac catheterization：可根据左室-主动脉压差计算瓣口