倪超-瓣膜病ppt培训课件

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1、ValvularHeartDiseaseNiChao,M.D.DivisionofCardiologyObjectivesTounderstandthepathophysiologyofthemajorVHDsTolearnhowtoexaminethepatientTounderstandtheprinciplesoflaboratorydiagnosisTolearnthefundamentalsfortreatmentofcardiacvalveabnormalitiesMitralStenosisEtiologyAlmostalways

2、theresultofrheumaticfeverLesscommoncausesCongenitalMSSystemiclupuserythematosusRheumatoidarthritisAtrialmyxomaBacterialendocarditis.EpidemiologyRareinindustrializedcountriesinpatients<40Verycommonindevelopingcountries,esp.SouthAsiawithseverediseaseoftenatearlyage(<20)2/3ofal

3、lpatientswithMSarefemale.Theonsetofsymptomsisusu.betweenthe3rdand4thdecades.PathologyThemitralvalvearea(MVA)isnormally4-6cm2inadultAcuterheumaticfevercausesimmune-medi-atedinflammationofthemitralandothervalvesTheleafletsthickenedandthecommissuresfusedalongwiththickeningandsh

4、orteningofthechordaetendineaenarrowingofthemitralvalveorificePathophysiologyMVAreducedto2cm2:increasedleftatrialpressure(LAP)isnecessaryfornormaltrans-mitralflowMVAreducedto1cm2:aLAPof25mmHgisrequiredarisein:Pulmonaryvenouspreesure(PVP)Pulmonarycapillarywedgepressure(PCWP)

5、exertionaldyspneaPathophysiologyProgressivedilationoftheLApredisposesmuralthrombiandatrialfibrillationChronicelevationofLAPpulmonaryhypertension,tricuspidandpulmonaryre-gurgitationrightheartfailurePathophysiologyPatientsathighriskareofmuralthrombiover35yearsoldatrialfibri

6、llationwithalowcardiacoutput(CO)havingalargeleftatrialappendage.Atrialfibrillationinupto40%ofpatientsdecreasesCOby20%.ClinicalManifestationsHistoriesofrheumaticfever,murmurDyspneaPalpitationsChestpainHemoptysisEdemaThromboembolismPhysicalExaminationLow-pitcheddiastolicrumble

7、OpeningsnapS1,atrialfibrillation,P2RVheaveElevatedneckveins,hepatomegaly,ascites,pedaledemaCoexistentmurmursThromboemboliceventsChestX-RayLeftatrialenlargementPulmonaryedemaProminenceofpulmonaryarteriesEnlargementofrightventricleEKGLeft,rightatrialabnormalitiesatrialfibril

8、lationRightVenticularhypertrophyEchocardiogramEnlargedLAMarkedlythickened,o