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《Chapter 61 – Acquired Heart Disease Valvular》由会员上传分享，免费在线阅读，更多相关内容在学术论文-天天文库。
1、CHAPTER61ACQUIREDHEARTDISEASE:VALVULARDavidA.FullertonandAldenH.HarkenJune1948,BaileyinPhiladelphiaandHarkeninBostoneachhistoricalperspectiveperformedasuccessfulclosedmitralcommissurotomy.Thereaf-diagnosticconsiderationster,itbecamewidelyusedtotreatmitralste
2、nosis.mitralvalveBythemid-1970s,theclosedtechniquewassupplantedbyaorticvalveopenmitralcommissurotomy.Althoughclosedmitralcommis-operativetechniquesurotomyachievedgoodpalliationofmitralstenosisforitsera,surgicaloutcomesopenmitralcommissurotomyofferedseveralad
3、vantages.First,choiceofprostheticvalvesthevalvuloplastycouldbeperformedunderdirectvision.Theprimaryreasonforfailureofclosedmitralcommissurotomywasresidualstenosis,notrestenosis.Inupto75%ofpatients,thesubvalvularapparatusofthemitralvalvecontributessignifi-Ste
4、noticorregurgitantcardiacvalvescreatehemodynamiccantlytothestenosis.Theopentechniquepermittedpreciseanddemandsononeorbothventriclesoftheheart.Thecompensa-maximaldivisionoffusedcommissures,aswellasfusedchordae.torymechanismsoftheventriclespermitthehearttotole
5、rateInaddition,calciumcouldbesharplydébridedfromthevalve,theselesionsforvaryingperiodsoftime,sometimesyears,beforeandanyresidualmitralinsufficiencycouldbecorrectedatthesurgicalinterventionisrequired.Ultimately,however,significanttimeofoperation.Finally,thecl
6、osedtechniquehadthedisad-valvularlesionsproducesystolicand/ordiastolicventriculardys-vantageofpotentiallydislodgingaleftatrialthrombus,resultingfunction,leadingtoheartfailure.Asageneralrule,surgeryforinintraoperativeembolizationandstroke.Today,however,openst
7、enoticvalvelesionsmaybedeferreduntilthepatientdevelopsmitralcommissurotomyisrarelyperformed;itwassupplantedsymptoms.Regurgitantvalvelesions,however,mayproducebyballoonmitralvalvuloplastybythemid-1990s.significantventriculardysfunctionbeforesymptomsdevelop;Su
8、rgicalattemptstocorrectaorticstenosisalsobeganin1therefore,surgeryinpatientswhodonothavesymptomsmaytheearly20thcentury.In1912,Tuffier,inParis,unsuccessfullybeindicated.Amongtheheart’svalves,thea
