机械及生物主动脉瓣病人选择及手术方式实施教材.pptVIP

机械及生物主动脉瓣 --病人选择及手术方式实施 ;;人工瓣膜的优缺点;9143 ;总体随访率为 91.2% 累及随访达 49232 病人?年 ;;;年龄 60 岁 并发房颤 有血栓栓塞的风险 首次感染性心内膜炎的患者;年龄 60 岁 不伴有房颤 无血栓栓塞的风险 进行三尖瓣置换时 具有生育要求的年轻女性患者 ;讨 论;讨 论;同期置换多个瓣膜的选择 避免使用不同种类瓣膜进行同期置换 育龄妇女瓣膜置换的选择 对有生育要求的年轻女性力争进行瓣膜成形术，必要时推荐应用生物瓣膜进行瓣膜置换。 ;双瓣同期置换术;四瓣膜同期置换(西京医院);;二尖瓣发育不良并重度关闭不全;;;Thank You !;;Yi Dinghua, Liu Jincheng, Yu Shiqiang, Yang Jian, Jin Zhenxiao, et al;;;cases;52%;;9143 ;Results;;; 60 years old Comorbided with atrial fibrillation Risk factor for thromboembolism Infective endocarditis (For the first time); 60 years old Comorbided without atrial fibrillation No risk factor for thromboembolism Tricuspid valve replacement Female patients with fertility require ;Indexed effective orifice area（IEOA）=0.85 2 mm smaller than the radius of the aortic annulus 19mm in patients with small aortic root Our sizes were smaller than that of western countries;Most selected mitral valve in adults is 27mm Smaller valve preferred in patients with small left ventricle or heart insufficiency 22 cases of valve replacement in patients under 45kg 3 cases of 19mm valve replacement in 3-12 months’ old infants;Discussion;Due to the calcification and deterioration of bioprosthesis, mechanical valve is preferred Need for re-operation Valvuloplasty should be the first choice in children Walfarin can usually be well tolerated in children;The criteria for first time is same to ordinary patients For re-occurred patients, bioprosthesis is preferred For patients with extensive annular defect or the detachment between ventricle and aorta, root replacement would be selected ;Concomitant multi-valve replacement Avoid select valves of different types For young female patients with fertility require Valvuloplasty is the first choice Bioprosthesis can also be used when necessary;Concomitant double-valve replacement;Concomitant four-valve replacement;;Congenital mitral valve insufficiency;;;Thank You !;