心脏瓣膜病(65p).pptVIP

Valvular Heart Disease Reading Klabunde, Cardiovascular Physiology Concepts CD ROM material on Valve Disease Overview of Valves Major Factors That Affect Flow Across Any Valvular Lesion The valve area The square root of the hydrostatic pressure gradient across the valve The time duration of transvalvular flow (applies to both systole and diastole) Valvular Heart Disease Increasing any of the major factors that affect flow across the valve increases transvalvular flow. Conversely, decreasing any of these major factors decreases transvalvular flow. Goals in Management of Various Valvular Lesions Regurgitant Lesions Reduce or minimize regurgitant flow across the mitral or aortic valve. Stenotic Lesions Maximize and enhance stenotic flow across the mitral or aortic valve Goals in Management of Various Valvular Lesions The valve area in regurgitant lesions can respond to changes in loading conditions (preload, afterload) The valve area with stenotic lesions is generally fixed Adult Valvular Heart Disease Aortic Stenosis Aortic Regurgitaiton Mitral Stenosis Mitral Regurgitation Hypertrophic Obstructive Cardiomyopathy Aortic Stenosis Aortic Stenosis Normal AVA = 2.6 – 3.5 cm2 Idiopathic Calcific Degeneration Congenital Bicuspid Endocarditis Other Paget’s Disease Systemic Lupus Erythematosus Aortic Stenosis Aortic Stenosis: Senile Natural History of AS May be a long asymptomatic period Symptomatic Usually have severe AS with AVA of 0.9 cm2 or less Presenting symptoms: Angina Syncope CHF Natural History of AS Symptomatic patients without surgery show the following average life spans: Angina = 5 years Syncope = 3 years CHF = 2 years AS is considered an independent risk factor for perioperative morbidity Survival of Patients with Valvular Heart Disease Treated Medically Pathophysiology of Aortic Stenosis Myocardial Function Develop left ventricular hypertrophy as an adaptation LVH reduces wall stress T =(Pr)/h LVH causes increased diastolic stiffness Ischemia i