老年性瓣膜性心脏病---主动脉瓣狭窄PPT.ppt

Joint Recommendations ofAmerican Heart Association and American College of Cardiology for aortic valve replacement in patients with aortic stenosis Aortic valve replacement indicated In patients with severe aortic stenosis with its classic “SAD” symptoms (syncope, angina, and/or dyspnoea In patients with severe aortic stenosis who are having coronary artery bypass grafting In patients with severe aortic stenosis having surgery on the aorta or other heart valves In patients with severe aortic stenosis with left ventricular systolic dysfunction (ejection fraction 50%) Aortic valve replacement possibly indicated In patients with moderate aortic stenosis having coronary artery bypass grafting or surgery on the aorta or other heart valves In patients with asymptomatic severe aortic stenosis with abnormal response to exercise (such as development of symptoms or asymptomatic hypotension) In patients with asymptomatic severe aortic stenosis if there is likelihood of rapid progression (age, calcification, and coronary artery disease) or if surgery might be delayed at the time of symptom onset In patients with mild aortic stenosis having coronary artery bypass grafting when there is evidence ofmoderate to severe calcification, suggesting thatprogressionis likely and may be rapid In patients with asymptomatic extreme severe aortic stenosis (aortic valve area 0.6 cm2, mean gradient 60mmHg, or a jet velocity 5m/s) when the patient’s expected operative mortality is ≤1% 外科治疗 内科治疗 内科药物治疗？不确切。 相关的治疗： 他汀类药物 ACEI 对症治疗 目前研究尚未解决的问题 AS是否类似于动脉粥样硬化过程是不断进展的，可以通过药物来干预？ 通过生活方式的改善或他汀类药物是否可以延缓AS的进程？ 准备做心脏手术的无症状的轻度或中度AS患者是否需换瓣？ 假设手术死亡率是低的，是否建议无症状的重度AS患者选择瓣膜置换术以减少以后的发病率和死亡率？ 目前正在进行的关于主动脉瓣疾病的他汀类药物作用的研究 STOP-AS—Stop aortic stenosis (Cleveland Clinic, Cleveland, Ohio, USA) SEAS—Simvastatin and the ezetimibe in aortic stenosis (Europe) ASTRONOMER—Aortic stenosis progression observation measuring effects of rosuvastatin (Canada) 谢谢 老年性瓣膜性心脏病 ---主动脉瓣狭窄 卫生部北京医院 何青 内 容 老龄和瓣膜