心脏瓣膜病 (126p).pptVIP

* Table 1. Classification of the Severity of Aortic Regurgitation. * Figure 2. Example of Quantitation of Aortic Regurgitation by the Convergence of the Proximal Flow. Panel A is a color-flow image of the aortic valve; the measured radius of the proximal flow convergence (R) is 0.74 cm, and the regurgitant flow is calculated as 138 ml per second. The aliasing velocity of 0.40 m per second (modified by baseline displacement) is the blood velocity at the junction of the orange and blue flows. Panel B shows a continuous-wave Doppler measurement of regurgitant blood velocity, at 455 cm per second (arrow). The effective regurgitant orifice area is determined by dividing the flow by the velocity, which in this case is 0.30 cm2. * Table 2. Guidelines for Indications for Surgery in Patients with Severe Aortic Regurgitation. * * * * * * * Significant Tricuspid Regurgitation 97% cases cause identified 85% cases secondary 15% organic TV disease Causes include: PHT, Cardiomyopathy: ischemic, non-ischemic, valvular heart disease Responds to primary problem Annular dilatation is important to note Ring Repair is to be considered Pathological process of tricuspid annular dilatation. Arrows designate the intercommissural distance that increases with dilatation and that is measured intraoperatively. Comparison of cardiac-related event free survival rates between the two groups. Group 1 = mitral valve repair (MR) (dashed lines); group 2= MR and tricuspid valve repair (TR). Dreyfus, G: Annal Thor Surg, Dec 2004 Percutaneous valvuloplasty for pulmonic valve stenosis Pulmonary Stenosis: Common congenital defect Mild to moderate PS in children has a generally benign clinical course Usually trileaflet, fused commissures mechanically dilated with balloon. Heavy calcification rare - well suited for balloon valvuloplasty. Not well suited for valvuloplasty - Noonan’s syndrome, primary fibromuscular subvalvular narrowing. 1982 – balloon valvuloplasty of PV introduced Clinical outcomes Treatm