高龄主动脉瓣狭窄的外科治疗吴清玉课件.pptVIP

Surgical treatment of senile aortic stenosis Qingyu Wu First hospital of Tsinghua University Background Aortic Stenosis (AS) is a common heart valvular disease The quantity of patients and the severity of disease is related to a growing elderly population Senility will lead to dysfunction of the organs, worse adaptation ability, severe and long term of disease; often combined with CAD, HP, arrhythmia, DM, and respiratory diseases , which need more attention on treatment Etiology Senile degenerative aortic stenosis most are calcified valvular disease Rheumatic heart disease (RHD) usually combined with other valvular disease Congenital heart disease (CHD) most are bicuspid aortic valve; patients will show symptoms around 50-60 years old Novaro GM, Griffin BP. An J Cardiol,2004,93:525-526 Classification According to the hemodynamic change and natural prognosis, divided into 3 levels ： Mild （valve area 1.5cm2） Moderate（valve area 1.0~1.5cm2） Severe （valve area ≤1.0cm2） When severe stenosis with normal cardiac output, PG usually 50mmHg Clinical Presentation Slowly progression Some are asymptomatic, and only cardiac murmur found by physical examination Around 1/3 will have palpitation, shortness of breath , chest pain, syncope, respiratory difficulty or pulmonary edema; some will develop heart failure Natural Prognosis Chest Pain mortality in 5 years(50%) Syncope mortality in 3 years(50%) Respiratory difficulty mortality in 2 years(50%) Heart failure mortality in 1.5-3 years (100%) Comparably, if apply AVR in time, the 10-year survival rate is similar to normal person after age correction Gulshan K S. Ann thorac Surg, 1988; 46:262-263 Roger V, Tajik A, Reeder G, et al. Mayo Clin Proc, 1996; 71:141-149.12 Diagnosis Signs and symptoms X-ray EKG Echocardiography Exercise Testing Cardiac cath