二尖瓣的病理生理学ppt课件.pptxVIP

Pathophysiology of Mitral Valve disease Alan Sihoe Cardiothoracic Surgery Teaching Round 2nd August 2002 1 Epidemiology • 1998 in the UK: – 6471 first time valve replacements – of which 28% MVR • Numbers increasing 2 Anatomy JUNCTION OF RCC AND NGC OF AORTIC VALVE X X—AVNODE/ BUNOLE OF HI5 AST LEAFLET × CIRCUMFLEX ARTERY CREAT CARDIACVEIN AV GROOVE POHLLEAFLEt 3 Antorior Cusp Dorsomediat Commissung Poslorier Cusp 4 Antorior Cusp Posterior Cusp Chordse Tendonse Antoriorolateral Commks surd Systole(Top Viow) Papillary Muscios Annulus Fibrosus Sysioke Oiaslole L ft Atrum Annular dynamics • Annular size – Increases in late systole (maximum in diastole) – Contracts in pre-systole (minimum in midsystole) • Annular shape – More eccentric in systole • Annular position – Moves up towards LA in diastole – Moves down towards LV apex in systole 5 Leaflet dynamics • Opening – Starts in center, moving to edges – Flapping of edges at max. opening • Closing (begins in late diastole) – Bulging at base/annular attachment – Leaflet ascends towards LA – Bulging ‘rolls’ from annulus to edge 6 Mitral Stenosis (MS) • Aetiology: Rheumatic – Male:female ratio is 1:2-3 – Acquired early (20 yo?) • But clinically manifest 10-40 yrs later – Definite Hx of RF in 50-60% – Pancarditis: mitral valve involved in 90% mitral valve alone in 40% 7 Mitral Stenosis (MS) • Rheumatic disease: – Leaflet thickening, calcification, retraction – Periannular calcification (restricted movement) – Commisural fusion: ‘fish-mouthing’ – Chordal thickening, shortening, fusion – Papillary muscle inflammation • Also: calcific congenital neoplastic thrombotic infective iatrogenic 8 MS: Hemodynamics • Diastolic AV pressure gradient – LA pressure may rise to 15-20 mmHg at rest – Gradient rises with exercise • Smaller valve area higher gradient • Inflow obstruction: i duration of LV filling – Hence reduced cardiac output – Exacerbated by h heart rate (e.