机械及生物主动脉瓣病选择及手术方式实施.pptVIP

总体随访率为 91.2% 累及随访达 49232 病人?年 年龄 60 岁 并发房颤 有血栓栓塞的风险 首次感染性心内膜炎的患者 年龄 60 岁 不伴有房颤 无血栓栓塞的风险 进行三尖瓣置换时 具有生育要求的年轻女性患者 有效开口面积指数（IEOA）=0.85 小于主动脉直径2 mm 在小主动脉根患者选择≥19mm 的人工瓣膜，必要时根部加宽 应用瓣膜尺寸小于国外报道，与我国西部身高体重特征有关 讨 论 推荐选择主动脉瓣小于二尖瓣4mm，如二尖瓣27mm＋主动脉瓣23mm；或二尖瓣25mm＋主动脉瓣21mm。 主动脉瓣较小时，不宜置换过大二尖瓣，否则左心室负荷过重，易于出现左心功能衰竭。 讨 论 生物瓣膜钙化和衰坏较快，选择机械瓣 再次手术置换较大瓣膜 小儿基本可以接受华法林抗凝治疗 应当尽量通过成形来修复 讨 论 首次手术治疗时选择的标准和非感染性心内膜炎患者相似 对复发的感染性心内膜炎的患者应使用生物瓣膜 在有广泛的瓣环缺损和心室主动脉分离时，采用同种主动脉根部置换 同期置换多个瓣膜的选择 避免使用不同种类瓣膜进行同期置换 育龄妇女瓣膜置换的选择 对有生育要求的年轻女性力争进行瓣膜成形术，必要时推荐应用生物瓣膜进行瓣膜置换。 双瓣同期置换术 Results Follow-up rate was 91.2% Accumulated follow-up time is 49232 patients?year 60 years old Comorbided with atrial fibrillation Risk factor for thromboembolism Infective endocarditis (For the first time) 60 years old Comorbided without atrial fibrillation No risk factor for thromboembolism Tricuspid valve replacement Female patients with fertility require Indexed effective orifice area（IEOA）=0.85 2 mm smaller than the radius of the aortic annulus 19mm in patients with small aortic root Our sizes were smaller than that of western countries Discussion Aortic valve 4mm smaller than mitral valve is recommended. I.E. 27mm M＋23mm A；25mm M＋23mm A When the aortic valve is small, big mitral valve should be avoided. Otherwise left ventricle overload will occur, leading to left heart failure. Due to the calcification and deterioration of bioprosthesis, mechanical valve is preferred Need for re-operation Valvuloplasty should be the first choice in children Walfarin can usually be well tolerated in children The criteria for first time is same to ordinary patients For re-occurred patients, bioprosthesis is preferred For patients with extensive annular defect or the detachment between ventricle and aorta, root replacement would be selected Concomitant multi-valve replacement Avoid select valves of different types For young female patients with fertility require Valvuloplasty is the first cho