三尖瓣修复手术策略演示幻灯片.pptVIP

修复手术适应症和手术术式 肺部或全身症状出现前应行手术治疗。 体外循环直视手术下取出异物，以防止感染赘生物栓塞。三尖瓣修复是手术的目的。自体心包片可用于进行瓣叶重建。如果可能应尽量避免使用异体组织材料。 起搏器依赖患者，我们倾向于选择心外膜同步起搏器植入，以防止心内植入物与重建瓣膜接触 。 病理 三尖瓣感染性心内膜炎 Gottardi R. et al., Ann Thorac Surg 2007; 84: 1943-9 病理 瓣环扩大 (LsVD,肺动脉高压) 创伤后三尖瓣关闭不全 类癌综合症中的三尖瓣狭窄 感染性心内膜炎 先天性解剖学异常 病理和修复手术类型 Ebstein′s 畸形: 三尖瓣环向右心室下移，并伴有不同程度的瓣叶畸形。 应同时修复三尖瓣和房室结构关系。不同临床中心根据各自的特点选择不同的手术方式。 病理 Ebstein 畸形 Da Silva et al., J Thorac Cardiovasc Surg 2007; 133: 215-23 非常感谢大家.我非常乐意回答大家的问题。 二尖瓣狭窄患者同时进行或未进行三尖瓣手术的结局 继发性三尖瓣关闭不全 Tricuspid valve repair strategies Prof.Dr.Rainer G.H. Moosdorf Medical Director Chairman Department for Cardiovascular Surgery University Hospital Giessen and Marburg Campus Marburg Pathologies The tricuspid valve is underestimated in its clinical importance and also under-represented in literature. Tricuspid valve disease is mainly seen as a consequence of other valvular dysfunctions. But: The correction of the mitral- or aortic- valve does not necessarily lead to an improvement of the tricuspid insufficiency. Outcome of patients after MVS with or without concommittant TV-surgery Outcome of secondary TVI Outcome of secondary TVI Outcome of patients after MVR with and without concommittant TV-surgery Outcome of patients after MVS with or without concommittant TV-surgery Outcome of secondary TVI Pathologies Annulodilatation (LsVD,PHt) Posttraumatic TI Tricuspid stenosis in Carcinoid syndrome Endocarditis Congenital malformations Indications for repair I know, I don′t know! In a literature review, many authors discuss the role of right ventricular dysfunction in the devellopment of tricuspid regurgitation: What is first and what comes second? Does simultaneous correction influence the longterm results? Outcome of patients after MVS with or without concommittant TV-surgery Outcome of secondary TVI Outcome of patients after MVS with or without concommittant TV-surgery Outcome of secondary TVI Indications for repair Whereas many questions are not definitively answered, there