三尖瓣关闭不全的外科处理.ppt

ppt课件 “ ” 2016 “ ” 三尖瓣关闭不全的外科处理 * ppt课件 The tricuspid valve: a neglected valvular lesion * ppt课件 History mitral valve replacement alone leads to resolution of severe functional tricuspid regurgitation and therefore tricuspid valve surgery was not indicated. （mid-1960s by Braunwald et al） the opposing view of routine valve repair for functional tricuspid regurgitation.（ late 1960s by Carpentier et al ） annuloplasty at the initial mitral valve operation in the 1970s * ppt课件 Tricuspid anatomy * ppt课件 Tricuspid physiology The closing mechanism of the tricuspid valve mainly depends on right ventricular contractility Left-sided valvular lesions may influence tricuspid valve function Physiological changes of tricuspid valve ring during cardiac cycle * ppt课件 Mechanisms of significanttricuspid regurgitation * ppt课件 Stages of primary and functional TR(Stage A-B) * ppt课件 Stages of primary and functional TR(Stage C-D) * ppt课件 Indications of TR Surgery 2014 AHA/ACC Guideline * ppt课件 Indications of TR Surgery 2014 AHA/ACC Guideline * ppt课件 How to deal with the tricuspid valve?A myriad of possibilities * ppt课件 Valve repair – Annuloplasty Reduction of the annulus without support Annular reduction supported by sutures Selective reduction supported by strips or pledgets of synthetic material Annular reduction by different types of prosthetic rings * ppt课件 De Vega annuloplasty Preservation of valvular mechanism It maintains the physiological flexibility of the annulus No prosthetic material is required No damage to the conduction tissue It is easy, fast to perform, cheap Classical De Vega Modification of De Vega * ppt课件 Classical De Vega annuloplasty * ppt课件 Why we need Annuloplasty rings Correction of annular dilatation Remodelling the shape of the annulus Improve coaptation between leaflets during systole Stabilization of repair over time * ppt课件 Annuloplasty rings Edwards MC3 Standard Carpentier–Edwards. * ppt课件 Biodegradable ring Poly-1,4-dioxanone polymer curved C-sha