(精选)心脏瓣膜病 Valvular Heart Disease (200p)教学课件.ppt

Pericardial Xenograft Obtained from calf pericardium. 3 leaflets formed from preserved pericardium mounted on Dacron frame. Blood flow is virtually unobstructed. Advantages disadvantages same as porcine xenograft Homograft Frozen AV of human cadaver. Harvested valve is thawed, trimmed sewn into place. No mounting material is needed Homograft Advantages: Excellent hemodynamics Little risk of clot formation Rare need for anticoagulation Disadvantages: Difficult to obtain Limited durability Only for AVR Pulmonary Autograft Ross Procedure: Subtitution of patient’s pulmonary valve for the aortic valve. Only replacement that is truly alive potentially able to last a normal lifetime without blood thinners Has been shown to grow with the rest of the body in young children AVR Median Sternotomy CPB Valve exposure/inspection of valve root surrounding to determine extent of disease Valve is sized Chosen valve is sewn into place Wean from CPB Steps in Aortic Valve Replacement: Risk Factors for Survival After AVR Increased age Decreased LV function CAD Endocarditis Mismatch of prosthesis body size NYHA Functional status Ascending Aortic Aneurysm Mitral Stenosis Indications for surgery: Surgery not usually recommended in asymptomatic patients Patients with few symptoms that are otherwise healthy should have surgery Patients with severe MS should have surgery Mitral Insufficiency Indications for surgery are more complex than for Mitral Stenosis Patients with MR become symptomatic only after LV function has been severely irreversibly damaged (at which time surgical results are much less favorable) Mitral Valve Repair Able to perform repair when: Prominent opening snap, no valve calcification Pliable leaflets, commissural fusion Normal chordae papillary muscle Closed Commissurotomy First mitral valve surgery to be performed First performed 1923; suggested as early as 1898 Rarely performed today Operative Technique Left Antero-lateral thoracotomy Pericardial sa