第08章心脏瓣膜病.pptVIP

Valvular Heart Disease;心脏瓣膜病 　是指心瓣膜及瓣下装置由于炎症、变性、粘连、缺血性坏死、创伤、老化或钙质沉着及先天性发育异常等原因，使单个或多个瓣膜发生急性或慢性的狭窄或关闭不全，导致前向血流障碍和/或返流的一组疾病。临床上最常受累的为二尖瓣，其次为主动脉瓣。 风湿性心脏病　简称风心病，仍是我国主要的心脏病，是风湿性炎症过程所致瓣叶损害。根据人群发病率调查已有下降趋势。;Mitral valve disease ;Mitral stenosis (MS);Etiology and Pathology（病因和病理）;Pathophysiology(病理生理);;　LA →PVP、PCP →lung congestion /pulmonary edema pulmonary artery intima hyperplasia and thickening　　　（肺动脉内膜增生肥厚）　　　PAP（肺动脉压升高）　　Right heart failure（右心衰竭）;Remarks (备注);Clinical situation(临床表现);Hoarseness（声嘶） Cough(咳嗽） LA增大压迫左主支气管，支气粘膜淤血水肿，易致感染 扩大的LA、肺A压迫喉返N ;Clinical situation;Laboratory examination(实验室检查); M型：二尖瓣前后叶同向运动 二维：狭窄瓣膜形态结构，瓣口面积， 　房室大小 连续多普勒：测定血流速度、跨瓣压　差 Cardiac catheterization (心导管术) 测定肺毛细血管压和左室压，确定跨瓣压差，明确狭窄程度;Diagnosis and Differential diagnosis(诊断和鉴别);Complication（并发症）;Complication（并发症）;Prognosis(预后);Therapy(治疗);Therapy(治疗);Mitral incompetence:MI;Etiology and Pathology（病因病理）;一、Chronic MI;一、Chronic MI;二、Acute MI　;Pathophysiology;Clinical situation(临床表现);Laboratory examination;Diagnosis and Differential diagnosis;Systolic ejection murmur in left border of sternum 生理性杂音 功能性杂音 主、肺动脉根部扩张 左或右室流出道梗阻; Atrial fibrillation Infective endocarditis Embolism Heart failure;Prognosis;Therapy;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;Aortic stenosis (AS);Etiology and Pathology;Pathophysiology;AS→After loading↑→LV hypertrophy→LVEDP↑ ;Clinical situation;Clinical situation;Laboratory examination;;Complication;Prognosis;Medicine therapy;PBAP: Percutaneous balloon aortic valvuloplasty (经皮球囊主动脉瓣成形术);Aortic incompetence;Etiology and pathology;Etiology and pathology;Etiology and pathology;Pathophysiology;Remarks (备注);