二尖瓣狭窄病变治疗进展知识分享.pptVIP

二尖瓣狭窄病变治疗进展;一、瓣膜性心脏病治疗原则;二尖瓣狭窄治疗原则;二、心衰内科药物治疗;2、二尖瓣狭窄合并慢性心衰的内科治疗 ;三、房颤处理;四、风湿热二级预防;五、心脏瓣膜病的介入治疗或外科手术;紧急PBMV;操作注意事项 ①操作敏捷，尽量减少不必要的程序 ②操作要准确，不可失误 ③此类患者主要是解决肺水肿，扩张二尖瓣要足够大。术者必须是熟练者，阜外医院有3例是在半卧位状态下，1位基础麻醉下完成操作;重症二尖瓣病变患者介入新技术;Chinese researchers first used a double-crowned fixation system on a Nitinol stent constructed around a homograft.(Ma L, Tozzi P, Huber CH, Taub S, Gerelle G, von Segesser LK.Double-crowned valved stents for off-pump mitral valve replacement.Eur J Cardiothorac Surg 2005; 28: 194 – 198);2. Transcatheter mitral valve-in-valve implantation;?Fluoroscopy sequence of transcatheter mitral valve-in-valve implantation in (A) a patient with prior aortic and mitral valve replacement. (B) The guidewire is placed through the mitral valve bioprosthesis and the Edwards SAPIEN valve subsequently delivered. After (C) slow and gradual expansion, (D) the SAPIEN valve is sufficiently anchored. ;(A) Two-dimensional echocardiography of the degenerated mitral valve bioprosthesis. The mechanism of failure was leaflet prolapse (*), (B) leading to severe regurgitation. After implantation of the SAPIEN valve, the prosthesis shows good anchorage with (C) full opening and (D) sufficient closure.;median follow-up ranging from 70 to 357 days Thirty days mortality was 7.5% (n = 3) ,late mortality was 10% (n = 4) All patients had improvement in postoperative NYHA class to I/II The mitral regurgitation grade was reduced from 3+ or 4+ preoperatively to a grade of 0 or 1 postoperatively There was no structural valve deterioration reported in the follow-up period in any of the studies;谢谢！