妊娠合并心脏瓣膜病的治疗马依彤.pptVIP

妊娠合并风湿性心脏病 常侵犯心脏和四个瓣膜， 各瓣膜承受压力负荷不同 受损的情况不同 依次为： ●单纯二尖瓣 ●二尖瓣合并主动脉瓣 ●二尖瓣合并三尖瓣 ●二尖瓣合并肺动脉瓣 * Percutaneous balloon mitral valvuloplasty was successful in 95% of patients, as evaluated by the Gorlin formula in the catheterization laboratory, and in 90.5%, as evaluated by the pressure half-time method 48 h after the procedure. Two patients had partial success in that their mitral valve area did not increase to .1.5 cm2. Pre- and post-PBMV hemodynamic data for these patients are shown in Table 2. Fetal and neonatal complications. In group I (PBMV), there was only one neonatal death in a premature child with an esophageal malformation. No fetal death occurred in group I. In contrast, there were six fetal and two neonatal deaths in group II (surgical group). The difference in the combined occurrence of fetal and neonatal deaths was significant when the groups were compared (1 vs. 8, respectively; p 5 0.025) (Table 3). Fetal deaths occurring up to 24 h after the operation and PBMV were 0 and 5, respectively (p 5 0.051). In the five patients operated on after 1990 for mitral stenosis without a pliable valve, a porcine mitral valve prosthesis was used, and there were three fetal losses. In the three patients who were submitted to mitral valve replacement for mitral regurgitation, there was one fetal loss. * Figure 5. In women with bioprosthetic valves, freedom from valve loss according to whether or not women had undergone pregnancies. Test of difference between pregnancy and no-pregnancy groups, P50.83. Circulation 1999;99;2669-2676 Robyn A. North, Lynn Sadler, Alistair W. Stewart, There were 11 operative deaths (4.7%) and 34 late deaths (14.7%). The operative death rate was 11.6% (95% CI, 3.9% to 25.1%) from 1972 to 1979, 2.9% (95% CI, 0.8% to 7.2%) from 1980 to 1989, and 4.1% (95% CI, 0.5% to 14.0%) from 1990 to 1992 (P50.10). The late death rate was 3 per 100 patient-years. Among the late deaths, 44% were valve related, 20% were cardiac but not valve rela