倪超瓣膜病ppt课件

Valvular Heart DiseaseNi Chao, M.D.Division of CardiologyObjectives To understand the pathophysiology of the major VHDs To learn how to examine the patient To understand the principles of laboratory diagnosis To learn the fundamentals for treatment of cardiac valve abnormalities Mitral StenosisEtiology Almost always the result of rheumatic fever Less common causesCongenital MSSystemic lupus erythematosusRheumatoid arthritisAtrial myxoma Bacterial endocarditis. Epidemiology Rare in industrialized countries in patients 20Natural History In industrialized countries, 20-25 year latent period between episodes of rheumatic fever and clinical signs of MS Once mild symptoms develop, progression to complete disability is very rapid (5 years) without intervention Time course more fulminant in developing countries ManagementMedical Salt reduction Diuretics Control of heart rate with digoxin Anti-arrhythmic drugs Prevention of thromboemboli with adequate anti-coagulants ManagementSurgical Interventional therapy indicated for mitral valve area of 1.0 cm2 Mitral commisurotomy or mitral valve replace-ment are common surgical approaches For selected patients (primarily young with pure MS), mitral balloon valvuloplasty is a successful option Mitral RegurgitationEtiologiesAcute Endocarditis (most often caused by Staphylo-coccus aureus) Papillary muscle rupture (from infarction) or dysfunction (from ischemia) Chordal rupture (from myxomatous valvular disease)Etiologies Chronic Rheumatic fever Mitral valvular prolapse Marfan syndrome Cardiomyopathy PathophysiologyAcute Abrupt elevation of LA pressure in setting of LA with normal size and compliance Backflow into pulmonary circulation with elevated PVP and PCWP and pulmonary edema Decreased forward flow of CO, hypotension and shock occur often Pathophysiology Chronic Gradual elevation of LA pressure with dilat-ation of LA and LV Increased preload and ecce