文档介绍：该【北京积水潭医院精品-心脏瓣膜病及缩窄性心包炎课件 】是由【zhilebei】上传分享，文档一共【66】页，该文档可以免费在线阅读，需要了解更多关于【北京积水潭医院精品-心脏瓣膜病及缩窄性心包炎课件 】的内容，可以使用淘豆网的站内搜索功能，选择自己适合的文档，以下文字是截取该文章内的部分文字，如需要获得完整电子版，请下载此文档到您的设备，方便您编辑和打印。心脏瓣膜病 及缩窄性心包炎 ---外科治疗Basic(1)HeartValvesBasic(2)Composition:MitralannulusValvularleafletsChordaetendineaePapillarymuscleLeftventricularwallLeftVentricle---plexBasic(3)ValvediseaseEtiologyCongenitalTraumaticRheumaticIschemicRetrogressionInfectivePathophysiologyStenosisInsufficiency(Regurgitation)MixedPathophysiologyDecreasedLVpreloadCOreductionSystematicmalperfusionIncreasedLApressurePneumonarycongestion&edemaPneumonaryhypertensionRightheartfailureCongestivehepatocirrhosisCardiogenicascites&edema病生理与临床表现病生理基础症状体征左室前负荷不足排血量下降心悸、乏力、外周发绀(二尖瓣面容)第一心音增强收缩压降低左房压升高左房增大、肺淤血胸闷、气促声音嘶哑房颤、左心功能不全组织器官灌注不足心慌气短、少尿、夜间阵发性呼吸困难脉短绌、心音强弱不等、心律不齐急性左心衰竭急性肺水肿端坐呼吸、咯血、咳粉红色泡沫痰奔马律双肺底细湿罗音肺动脉高压慢性右心功能不全静脉回流障碍面颊潮红、多汗、腹涨、食欲减低、营养不良、消瘦、恶病质P2亢进、颈静脉怒张、肝大、腹水、全身水肿临床表现与诊断典型心脏杂音:心尖部舒张期隆隆样杂音。ECG:P波高尖、房颤律、右室肥厚、电轴右偏、X-ray:左房扩大、心脏扩大呈“二尖瓣型”、肺血增多。UCG:左房扩大、二尖瓣增厚、活动度减低、瓣口面积缩小、跨瓣流速加快呈“射流”、跨瓣压差增大,M型超声显示二尖瓣频谱呈“城垛样”改变。MitralInsufficiency(Regurgitation)PathologiclesionsAnulardilatation&calcificationLeafletprolapseChordalrupturePapillarymuscledysfunctionorruptureInfectiveendocarditisVentricularaneurysmsCongenitalmalformationIndicationsforoperationMS(moderateorplus),,mixedlesions(stenosis&regurgitation).Rheumaticmitralvalvedisease,NYHA>IIclass;(moderateorplus),withLVdilatation(IschemicorDystrophic).Acute&severemitralregurgitationpost-AMI,,-prosthesesvsMechanicalprosthesesBiologicalMechanicalWorkinglife10—15yrs>40yrsAnticoagulationOnlyforpermanentAFLifelongQualityoflifeBetterOKComplicationsofanticoagulationRareIndependentriskofpostoperativedeathRe-dooperationYesRareBio-prostheses::