《心脏瓣膜病》课件.ppt

LaboratoryexaminationX－RayECGEchocardiogram二维超声：可显示二尖瓣的形态结构，提供心室大小，明确病因彩超连续多普勒：可用于二尖瓣心房侧探及收缩期射流，半定量返流量DiagnosisandDifferentialdiagnosis心尖区SM＋心房、心室增大，诊断MI可成立，确诊有赖于超声心动图应与以下情况相鉴别：Tricuspidincompetence（三尖瓣关闭不全）：胸左缘4、5肋间SM，可传至心尖区，杂音吸气时增强，伴颈静脉收缩期搏动，RV↑↑VSD（室间隔缺损）Systolicejectionmurmurinleftborderofsternum生理性杂音功能性杂音主、肺动脉根部扩张左或右室流出道梗阻01Atrialfibrillation02Infectiveendocarditis03Embolism04HeartfailureComplicationPrognosis急性严重返流者，若不及时手术，极难存活慢性MI无症状期长，一旦发生左心衰竭，预后不良PreventendocarditisandrheumaticfeverPatientswhoareasymptomaticandhavingnormalcardiacfunctionneedn’ttherapybutregularfollow-up(定期随访).Complicationarecuredinpatientswithcomplication.TherapyMedicaltherapy(内科治疗)SurgicaltreatmentProstheticvalvereplacement为主要手术方法，趋向早期手术有症状者应在LVEF＜0.5，平均肺动脉压＞20mmHg之前手术产生左室功能不全、LVEF0.3－0.5、年龄＞55岁、LVEDD≥80mm，已不置换瓣Valvuloplastyofmitralvalve(二尖瓣整复术)优点：不需长期抗凝，LV功能恢复较好AorticValveDisease主动脉瓣疾病Aorticstenosis(AS)主动脉瓣狭窄EtiologyandPathologyRheumaticheartdisease：风湿性炎症所致瓣膜交界处融合、瓣叶纤维化、钙化，引起瓣叶狭窄畸形，多伴AI及二尖瓣损害Congenitalbicuspidvalve(先天性二叶瓣)Senilecalcific(degenerative)AS(退行性老年钙化性主动脉瓣狭窄)：65岁老年人AS的常见原因，瓣叶主动脉面钙化结节限制瓣叶活动PathophysiologyThecross-sectionalareaoftheaorticvalveorifice(瓣环口面积）Normaladult≥3.0cm2Thearea≤1.0cm2,LVSP↑,transvalvepressuregradientmanifest(跨瓣压差明显)AS→Afterloading↑→LVhypertrophy→LVEDP↑LAamplification↓PAPPCP↑↓LungcongestionandedemaMyocardialischemia↓Myocardialcontractility↓↓HeartfailureClinicalsituationSymptomASTriplesyndrom(AS三联症)Dyspnoea(呼吸困难):LungcongestionAngina(心绞痛)CausingbySynocope(晕厥)cardiacoutput↓ClinicalsituationPhysicalsignCardiacsound:S1isnormal,S2isparadoxicalsplitting(逆分裂),S4maybeheardCardiacmurmur:：SMishea