医学ppt课件心脏瓣膜病.pptVIP

Valvular Heart Disease;Introduction;Mitral Stenosis;Pathology;Valve orifice area  normal 4-6cm2 mild stenosis 1.5--2.0cm2 moderate stenosis 1.0—1.5cm2 severe stenosis 1.0cm2;Two types:  1．Septum type 2．Funnel type; 1．Septum type ·only leaflets involved, without obvious shortening ·rare complicated with incompetence due to good elasticity of leaflets ·no dilation of LV ·prominent S1, with opening snap ·percutaneous balloon valvuloplasty is preferred to relieving the stenosis; 2．Funnel type ·leaflet, chordae tendineae and papillary muscle are all invloved · common complicated with incompetence due to poor elasticity of leaflets  ·S1 decrease ·valvular replacement is preferred to relieving the stenosis;;[Pathophysiology]1．Stage of left atrial compensation ·early stage，mild stenosis ·the pressure gradient across mitral valve 20mmHg，left atrial mean pressure 25mmHg ·clinical asymptomatic, with cardiac murmur;[Pathophysiology]1．Stage of left atrial decompensation ·moderate and severe stenosis ·the pressure gradient across mitral valve 20mmHg，left atrial mean pressure 25mmHg ·elevated left atrial pressure, pulmonary congestion and pulmonary hypertension  · with apparently clinical symptoms;Mechanisms of clinical manifestation: pulmonary venous congestion, pulmonary edema – similar with ↗ left heart failureLA failure ↘pulmonary hypertension, right ventricular hypertrophy – right heart failure? ↗ down transfer of elevated LA pressure main causes → reactive constriction of pulmonary arterioles of pulmonary →obstructive changes of pulmonary vascular bed hypertension ↘recurrent pulmonary infection and overfatigue;Pathophysiology;Clinical manifestion;Clinical symptoms;Auxiliary examination;;;Diagnosis and differential diagnosis;complication;Treatment ;Treatment;Treatment;;Mitral Incompetence