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

Valvular Heart Disease ;;;;;;Calcified Ao Valve 2nd to acquired AoV Stenosis;Severely calcified tricuspid valve from an elderly patient;;Phonogram of a 20yoa women with moderate AoV congenital stenosis with a bicuspid valve, presenting with an ejection click, increased A2 and systolic ejection murmur;Phonogram of a 20yoa male with severe non-calcified AoVS. Seen here is a paradoxical splitting of S2, late systolic ejection murmur and prominent S4. The LV is noted to have a low volume and a slow up swing of the carotid pulse.;Apexcardiogram of the severe AoVS showing a sustained “a” wave, causing a palpable S4 gallop (the non-compliant ventricle);70yoa male with sever AoVS, note the absence of both the ejection click and Ao second sound (circled). Also there is a slow up swing of the carotid pulse.;;The window to the inner world – The Eyes Note the multiple calcific emboli in the retina of this elderly patient presenting with amaurosis fugax Patient was Dx with severe acquired AoVS;;;;;;;;Catheter gradients are reported as peak to peak pressure differences This is not a true measurement of pressure drop off across the AoV because they do not occur at the same time Echocardiogram is ideal for pressure drop off across the valve The two should be used together to evaluate the patient for validation studies Peak to Peak pressure diff Pressure Drop off;;Percutanous valvuloplasty with a prophylactic RV Pacemaker to combat bradycardia during the procedure;Ross Procedure;Survival in the elderly (ave age of 60) after a AoV replacement (AVR);Pt with Marfan’s syndrome;Marfan’s with type-A Ao dissection ;;;;;;Growth the heart muscle;r h;;;Pulse and Reflected wave velocities in an elastic Ao;What about in a stiff aorta?;;;;;;;;;;;;;Pre and Post op CXR of a patient with AoV Regurgitation Note the decrease in long and short diameters from the Starr-Edwards valve replacement procedure;Typical LVH associated with AoVR with a strain pattern and tall T-waves;;LV wall stress can