二尖瓣修补的方法东方的观点.ppt

二尖瓣修补的方法东方的观点Dr.TimWing-KukAuFRCS,FHKCSConsultantSurgeonHonoraryClinicalAssistantProfessorDepartmentofCardiothoracicSurgeryTheUniversityofHongKong,QueenMaryHospital,HongKongSAR心血管治疗领域中的新起点 December2008Shanghai,ChinaClevelandClinic

无症状二尖瓣返流治疗结果的定量分析MauriceEnrique-Saranetal.NEnglJMed2005;352:875-83

二尖瓣返流的概述GrigioniF.JACC199934;7:2078-85OttoC.NEnglJMed2001,345;10:740-6

Enrique-Saranetal.Circulation.1994;90:830-37

Shuhaiberetal.EurJCardThoracSurg.2007;31:267-75ChordsOlivieria1983Survival1.230.384.04Chords1.230.384.04DegenGillinov2003Survival1.671.302.15DegenLee1997Survival1.420.842.40DegenMohty2001Survival1.751.242.46DegenYacoub1981Survival2.340.916.05Degen1.681.392.02IschemicCalifiore2004Survival0.780.193.16IschemicCohn1995Survival0.530.181.53IschemicGrossi2001Survival1.340.921.95IschemicMantovani2004Survival1.480.425.20Ischemic1.180.831.69MixedAdebo1984Survival1.480.336.70MixedAkins1994Survival1.600.763.36MixedCraver1990Survival1.160.393.50MixedEnriguez-Sarano99?Survival1.641.132.38MixedGalloway1989Survival1.551.022.35MixedHausmann1999Survival0.860.581.26MixedKawachi1991Survival4.330.6429.34MixedPerier1984Survival2.391.304.37MixedSand1987Survival1.631.042.57MixedThourani2003Survival1.531.261.86Mixed1.491.241.78RheumaticAntunes1987Survival2.131.283.53RheumaticYau2000Survival2.651.474.78Rheumatic2.331.593.43Overall1.581.411.78危险比

修补vs置换血流动力学更稳定维持心室的功能避免使用人工瓣膜不会出现血栓栓塞和出血感染机率降低

分型瓣叶运动描述Ia正常瓣环扩张Ib瓣叶穿孔IIa过度腱索延长IIb腱索破裂IIc乳头肌梗死/延长IIIa受限瓣叶缩短或粘合或腱索融合IIIb左心室功能异常或动脉瘤导致瓣叶圈合IV不定乳头肌功能失调退行性二尖瓣返流的Carpentier分级

前瓣叶–瓣叶转位

人工腱索–Gore-Tex5/0

人数死亡率STS数据库1.5%Gillinov200835440.3%DeBonis3%Suri*2006641.6%*David7%Kasegawa3%Nakajima2005160.0%Cinghatanadgige2003432.3%Song0%

退行性二尖瓣返流东方=西方TEE的重要性返流束的方向判断容易出错盐水注射试验:有或无Barlow’s–罕见但是很困难

分型瓣叶活动描述Ia正常瓣环扩张Ib瓣叶穿孔IIa过度腱索延长IIb腱索断裂IIc乳头肌梗死/延长IIIa受限瓣叶缩短或粘合或融合IIIb左心