心脏瓣膜病再次术的治疗策略.ppt

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1、心脏瓣膜病再次手术的治疗策略广东省人民医院广东省心血管病研究所卢聪恩苑龟椒惑狡谨衔搪著你羽廷径袱素校蓬樱哦贸燕也酥粱昂芍褪宝枚阔案心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略中国瓣膜外科发展史中的几个里程碑1954 1954 第一例闭式扩张术第一例闭式扩张术1958 1958 体外循环的首次应用体外循环的首次应用1958 1958 第一例体外循环下二尖瓣直视分离术第一例体外循环下二尖瓣直视分离术1965 1965 第一例瓣膜置换术第一例瓣膜置换术风蔷奎青戌量业滓届哮扒址哗巷啪信敦毛敲诽寺卖等庆躇于缉闺狭凹风敌心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略瓣膜外科发展史中的领军人物

2、及科研院所蔡用之：长海医院蔡用之：长海医院张宝仁：长海医院张宝仁：长海医院郭加强：阜外心血管病医院郭加强：阜外心血管病医院罗征祥：广东省人民医院罗征祥：广东省人民医院榨逗万贮壤罐吱大宁呜来波踞椒锦基根吱航泊主坐炎砚巩铣籽充拽驭配蠕心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略手术数量及再次手术问题uu至1999年，每年瓣膜手术达6000例uu经过近10年的发展，现在每年的瓣膜手术估计在2-3万左右uu随着手术数量的增多，再次手术成为不可避免的问题步痢担却赵认辅归臆按穿者曳吵傀烁蓟沼殿频胖菏召孽询个倘屈娟遏涨养心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略我院的经验我院我院19971

3、997年至年至20072007年瓣膜手术情况年瓣膜手术情况用拂躲桑碴试蜒透坛径祥鹏他读梳画涂普镭同谋银桅叼宾舵辟但呀钩偶灸心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略我院的经验19971997年至年至20072007年总瓣膜手术例数：年总瓣膜手术例数：67036703例例其中再次手术例数：其中再次手术例数：499499例，占例，占 7.4%7.4%再手术病人围手术期死亡率：再手术病人围手术期死亡率：8.8%8.8%糜行詹循粮疼再弟锌艰脑钞匪太驹堑形恋狠玉菠魂右贩顿敬字寅吝枷洛硝心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略再次手术的原因分析占比重最大的为：占比重最大的为：占比重最

4、大的为：占比重最大的为：二尖瓣闭式扩张术后（二尖瓣闭式扩张术后（二尖瓣闭式扩张术后（二尖瓣闭式扩张术后（64.5%64.5%）氏猩恩勘潦宋航恨何甄纺勾任呜计懒号磁惕哺赋嫌阅水肋裹悉探嘿朽惦遥心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略国内其他医院再次手术的原因分析医院名称医院名称再次手术例数再次手术例数原因原因阜外医院阜外医院333333a,b,c,d,e,fa,b,c,d,e,f新桥医院新桥医院187187f,a,d,gf,a,d,g仁济医院仁济医院203203f,a,g,f,a,g,福建省立医院福建省立医院104104f,e,g,d,a,hf,e,g,d,a,h包头中心医院包头中心

5、医院165165f,a,g,c,d,b,ef,a,g,c,d,b,ea:生物瓣失功能，b:瓣周漏，c:自然瓣膜损坏，d:机械瓣功能障碍，e:感染性心内膜炎，f:二尖瓣闭式扩张，g:二尖瓣直视分离，h:其他,甭跪敷障棱琵氢环宪份渡频薯但制瓷借谜额找玩屁逆陶贾友鹊亿稀放晚泞心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略风险及对策再次瓣膜手术的风险比首次瓣膜手术的风险高 病程长 心功能差 粘连、手术时间长 出血针对不同的原因，其治疗方案及对策有所不同仟娠告雏诉匀游跳粗信呢熏芋萎烧削赣闷瞅街瞒样忌徒还槐隘摹阂湛柞江心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略闭式扩张及直视交界切开术后再狭

6、窄风湿性心脏病是导致瓣膜病变的首要原因风湿性心脏病是导致瓣膜病变的首要原因再狭窄是必然结果，闭式扩张术后的症状缓解期再狭窄是必然结果，闭式扩张术后的症状缓解期一般在一般在8-158-15年年特点：病程长，常合并三尖瓣病变特点：病程长，常合并三尖瓣病变策略：策略：再次成形再次成形 换瓣换瓣 ：生物瓣（避免抗凝治疗）：生物瓣（避免抗凝治疗）机械瓣机械瓣 誉咐准逊父宰昔刑堤衙黑豫跋嫡裕且轻簿钙箭坤骤锅古涛费袋液潮枷芳汲心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略机械瓣功能障碍机械瓣结构原因机械瓣结构原因机械瓣梗阻：机械瓣梗阻：血管翳、纤维组织增生血管翳、纤维组织增生 血栓形成：多发生于血栓形

7、成：多发生于3 3年内年内梗阻原因梗阻原因MVRMVRAVRAVRTVRTVR血栓形成血栓形成35(71%)35(71%)8(33%)8(33%)4(100%)4(100%)血管翳及纤维组织增生血管翳及纤维组织增生14(29%)14(29%)16(67%)16(67%)逝拽行圭凋辗石些烘咽学磊央工愁檄嚏瘩瞻频股糠臂洒径顾硫咀帜梗捍士心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略机械瓣功能障碍机械瓣功能障碍策略血栓：内科溶栓血栓：内科溶栓 外科再次手术治疗外科再次手术治疗血管翳、纤维组织增生：再次手术治疗血管翳、纤维组织增生：再次手术治疗强调早期严格抗凝治疗，不同部位其抗凝标准有强调早期严

8、格抗凝治疗，不同部位其抗凝标准有所不同：所不同：AVRAVR：INR 1.8-2.0INR 1.8-2.0MVRMVR：INR 2.0-2.5INR 2.0-2.5TVRTVR：INR 2.5-3.0INR 2.5-3.0察啮柄胆钝盖瞬谴肪蜀屏损恳诱杂郑桅抖淬忧嘲活戍雨肖漾澎湾催囊藏盾心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略妊娠期机械瓣功能障碍原因：（1）妊娠期高凝状态 （2）担心华法林的副作用 （3）在妊娠早期停用或换用其他抗凝药物什绍甭惩凉锨柴匪色昔塔铭忌此仿轿稗锻桓嗡漳暮袄使娄欲押者酸假馆酣心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略我院临床资料2000年2月至200

9、6年12月，妊娠期发生机械瓣功能障碍病人7例，年龄22-32岁，平均26.4 2.6岁风湿性心脏病5例，先天性心脏病2例心功能IV级4例，III级3例妊娠期28周5例，28周2例机械瓣血栓形成，机械瓣梗阻妊娠期机械瓣功能障碍妊娠期机械瓣功能障碍约狼虽杜揪站玫正勿汁屡叔涛乌寨讣词惧愿歧孕妊杰肺瘟哑虱纫舍檀赵鲁心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略外科治疗方法同期剖腹产和CPB下心脏瓣膜再次置换术；CPB下再换瓣手术，同时对宫内胎儿监测与保护。先行剖腹产，密切监测心功能妊娠期机械瓣功能障碍妊娠期机械瓣功能障碍摧筏掖惭坏国檄卡患炎检牲蓄扯怕忻睬泪怜仍痪此脏涡慧赞梭医暗工达著心脏瓣膜病再

10、次术的治疗策略心脏瓣膜病再次术的治疗策略结果孕妇全部存活，无围手术期及远期死亡.剖腹产婴儿5例，均存活；无畸形，随访生长发育及智力水平正常.孕期体外循环心脏手术：一例胎儿死亡；一例存活.妊娠期机械瓣功能障碍妊娠期机械瓣功能障碍礼阅蹄僧始肌吮伯持征廉时弄蚀载潦境饱文献珠啄乞绅定衷婴煤峰掩笔辅心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略外科决策机械瓣失功能+妊娠期6个月？妊娠期机械瓣功能障碍妊娠期机械瓣功能障碍因饰耽锯下锗逗冗妙拆审啪惕谣疟庞坯赔府汰坦斡稠傣幢刀磕笼搅夏犊囤心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略机械瓣梗阻程度心功能情况妊娠期周数及胎儿的情况患者及家属的意愿心脏

11、外科医生的经验及业务水平涉及的有关专科的技术水平影响外科决策的因素妊娠期机械瓣功能障碍妊娠期机械瓣功能障碍讶捣枉亮戴的础隔甥章本蛋略倔究酌钞锑梭冻碗刺骇铱呆统宽茄蝴纬抛诅心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略面临的挑战大批育龄妇女在换瓣术后有怀孕的需要孕期的抗凝不规律问题如何预防和处理妊娠期发生瓣膜失功能低温体外循环对母体和胎儿的影响多学科如何协助治疗妊娠期机械瓣功能障碍妊娠期机械瓣功能障碍真稽挥歌湘煞膏云衰瓮顷盎瞥厘贷莎芯叛萧白它枯防钾泵男蜒腐威廓滴曙心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略左心瓣膜置换术后三尖瓣返流是一个易受忽视的问题显著影响长期生存率Nath J

12、,et al,J Am Coll Cardiol,2004;43,405惩留灯入氨馅柯扯禹绥廉郊茨想明链颊配匀赁湾棉唾文硬妇婿历淡祥深吉心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略机制 肺动脉高压 三尖瓣环扩张 心房纤颤 风湿性病变的进展 成形技术的局限性 Xuejun X,et al.Heart Lung and Circul,2004;13,65 Xuejun X,et al.Heart Lung and Circul,2004;13,65左心瓣膜置换术后三尖瓣返流左心瓣膜置换术后三尖瓣返流套伙信纪浚走枢菩绕蛹汰狼敦崎舌镑滥寨鉴蒲益贞遭煌苹抖闸控敷识性雁心脏瓣膜病再次术的治疗策略心

13、脏瓣膜病再次术的治疗策略处理策略再次成形：Devegas，瓣环成形，如何选择瓣环种类瓣膜置换：金属瓣：血栓风险 生物瓣：近几年多采用左心瓣膜置换术后三尖瓣返流左心瓣膜置换术后三尖瓣返流哀换颓羔涯咙粉奶华噶碾着拙浊豪丝佣巷馈童程空乔涝敬珍叫反瞅磺灵料心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略有待解决的问题l l左心瓣膜置换术后三尖瓣返流的原因l l选择成形术的标准l l选用何种成形方法l l如何选择瓣环的种类和大小l l选择瓣膜置换术的标准l l如何预防三尖瓣返流左心瓣膜置换术后三尖瓣返流左心瓣膜置换术后三尖瓣返流霜雏燕奔茎亥可凶丈播傈酌敝驮炭探滨游绞题盾郊巩修蹭隆膛炽瘁曰孕钎心脏瓣膜

14、病再次术的治疗策略心脏瓣膜病再次术的治疗策略二尖瓣成形失败瓣膜成形术所占的比例不高瓣膜成形术所占的比例不高 在我国瓣膜病以风湿性病变为主，在我国瓣膜病以风湿性病变为主，病人就诊晚病人就诊晚 成形技术未能普遍开展成形技术未能普遍开展 担心成形失败而需再次手术担心成形失败而需再次手术 禁跋评瓜搪娱赦吊惟摸雁寝邪据娜芜步只稻充慢宦慕橙泞娘柏港韭伺仲纸心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略外科治疗方法再次成形术瓣膜置换术经导管瓣膜植入术 “环中瓣”二尖瓣成形失败二尖瓣成形失败堑炭万嗡族膨蓝堆躇诚赠商沉蚤射悟褒匣晴肃功逊怖樊赴虎耐枯聘古帧谢心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策

15、略如何预防掌握二尖瓣成形术的指征采用合适的成形方法术中食道B超检查二尖瓣成形失败二尖瓣成形失败斑沂硫樟喝吼辞黎惰铺梨居黔汤木谭拐概妈肆国唯刚暖烟钩谅一伎揖敦样心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略实时三维实时三维TEETEE在二尖成形术中的应用在二尖成形术中的应用Post RepairPost RepairPre RepairPre Repair二尖瓣成形失败二尖瓣成形失败刷仍发黄驳竿趾迹窃忙骋象锁钞阅份搭看铸诸讹刀蹬迹邦藤撮冶镐夜债绵心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略展 望随着外科技术及围手术期处理水平的提高，再次手术病人死亡率将下降介入及微创技术的进步可减少

16、再次开胸手术Edwards LifesciencesEdwards Lifesciences敝井营弛寝臃恐途圈胆首帕执椎点樱剿分北钓瞳八盂限籽审扒八薄粪答卖心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略经导管主动脉瓣植入术的初步实验经导管主动脉瓣植入术的初步实验经导管主动脉瓣植入术的初步实验经导管主动脉瓣植入术的初步实验务御颈皇远秸譬铝亮嘿玻谤羚牛资硝森耍甜混撼珠蔡愈棚归求彦邀嫩筛滤心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略THANK YOU潦允可蓉彩今哺尹易冒福艰见疯竭盯涡杰攀偏皋坍劈守骋挺渭蛊弹瞪柜蛊心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略豢凑苑辽泵终及缚毁隧元

17、固基门棘恿谰业耀损尘逼洁雏枕帝飞帽齿畸亭吊心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略Strategies of Re-operation in Heart Valve DiseaseCong Lu,MDCong Lu,MDGuangdong General HospitalGuangdong General HospitalGuangdong Provincial Cardiovascular InstituteGuangdong Provincial Cardiovascular InstituteGuangzhou,ChinaGuangzhou,ChinaGuangdong Ge

18、neralHospitalGuangdong ProvincialCardiovascular Institute觅怠肌虏燥唾拆促乙挛追洱厌刀唁触翻藻脓树菌塘腆炊泥吹禽远涟囤业境心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略Relevant Historic Milestones in China1954 1954 Closed mitral commissurotomy1958 The first application of CPB1958 The first application of CPB1958 1958 Open mitral commissurotomy by CPB1

19、965 Mitral valve replacement1965 Mitral valve replacement袜砾张酬矣矗蓬畸泅摊若掠羔济鹰伯茄龋掳棘瓤饯孽粟拥柄拇丘阁头充宇心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略Eminent Pioneers and Institutions of China Cai YongzhiCai Yongzhi Changhai Hospital Changhai Hospital ShanghaiShanghaiZhang BaorenZhang Baoren Changhai Hospital Changhai Hospital Shangh

20、aiShanghaiGuo JiaqiangGuo Jiaqiang Fuwai Cardiovascular Hospital Fuwai Cardiovascular Hospital BeijingBeijingLuo ZhengxiangLuo Zhengxiang Guangdong General Hospital Guangdong General Hospital GuangzhouGuangzhou慢坤父娜蓉偶派敖扳冕蔼膳臻炎力濒烈朴幂儡腾诀始奸疑蛊勾忻饯成厉籽心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略Operations and Re-operationsBy t

21、he late 1990s,6000 heart valve operations performed each yearIn recent years,the number of valve In recent years,the number of valve operations per year is more than 20 000 operations per year is more than 20 000 With the number of heart valve surgeries With the number of heart valve surgeries incre

22、asing,re-operation of heart valve increasing,re-operation of heart valve disease becomes an unavoidable problemdisease becomes an unavoidable problem 七尧彝崖火智武洼娄烃休煞坛肥劈鸽褥峻粱阅润雌蛊溶妓致贰迢佰歼慌锌心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略The Experience of Our HospitalHeart valve surgeries in Guangdong Heart valve surgeries in Gu

23、angdong General Hospital from 1997 to 2007General Hospital from 1997 to 2007缺喧藉覆读岿鸥捉侵旦榜勤程组锥炒搽桅沁蛔龟格汝胯三充轰艰浅音团各心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略The Experience of Our HospitalThe total operations from 1997 to 2007The total operations from 1997 to 2007：6703 cases 6703 casesRe-operationsRe-operations：499 cases49

24、9 cases (7.4%)(7.4%)Perioperative mortality of re-operations Perioperative mortality of re-operations：8.8%8.8%共益鸣亡徽讯舒敖扯服赌致隆闷衅疡萍热暂秽罕零药达氛醒返悟寡和驴呆心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略Causes of Re-operationThe leading causeThe leading cause：Re-stenosis after closed mitral Re-stenosis after closed mitral commissurot

25、omycommissurotomy（64.5%64.5%）烃拭地渴盅妄崭门虞阜强柿沛菲眷给苍最伶藤赌凄藐正绑琼打寂骄哑魁帛心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略Causes of re-operation of other hospital HospitalHospitalRe-operationRe-operationcausescausesFuwai HospitalFuwai Hospital333333a,b,c,d,e,fa,b,c,d,e,fXinqiao HospitalXinqiao Hospital187187f,a,d,gf,a,d,gRenji Hospit

26、alRenji Hospital203203f,a,g,f,a,g,Fujian Provincial HospitalFujian Provincial Hospital104104f,e,g,d,a,hf,e,g,d,a,hBaotou Central HospitalBaotou Central Hospital165165f,a,g,c,d,b,ef,a,g,c,d,b,ea:bioprosthetic failurea:bioprosthetic failure，b:perivalvular leakage b:perivalvular leakage，c:lesion of nat

27、ural valvec:lesion of natural valve，d:dysfunction of mechanical valve d:dysfunction of mechanical valve，e:endocarditise:endocarditis，f:closed mitral commissurotomy f:closed mitral commissurotomy，g:open mitral commissurotomyg:open mitral commissurotomy，h:others h:others混耘黑织遮泊锡溢写肯钙谐官奴越覆记苦矣糖杖倚溪陕漏遣戎挣揍颠仇

28、狠心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略Risks and StrategiesRisks are higher of re-operation than Risks are higher of re-operation than initial operationinitial operation pro-longed history pro-longed history poor cardiac functionpoor cardiac function adhesionadhesion bleedingbleedingA variety of methods and str

29、ategies of A variety of methods and strategies of management should be applied according management should be applied according to different causes leading to re-operationto different causes leading to re-operation荔勇炔雍名旗啪慨植薯挞擎梦水骏建斗橱负魏妇梯艾距件唆肥耘集蝇溺沂心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略Restenosis after Closed or O

30、pen Mitral Commissurotomy Was widely done with good results in ChinaRestenosis is unavoidable Restenosis is unavoidable CharactersCharacters：pro-longed historypro-longed history，often often concomitant with tricuspid regurgitationconcomitant with tricuspid regurgitationStrategiesStrategies：re-repair

31、 re-repair prosthetic valve replacement prosthetic valve replacement：bioprosthetic valve bioprosthetic valve mechanical prosthetic valve mechanical prosthetic valve晌杉肝浙僚绕鉴吐础衅臼渝笺圈寇嗡凉耙莽嘛炳码岩趁酪淄仗巢泅紫音茧心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略Dysfunction of Mechanical Prosthetic ValveProsthetic valve structureProsthetic

32、 valve structureObstruction of mechanical prosthetic valveObstruction of mechanical prosthetic valve pannus,fibrous tissue accrementitionpannus,fibrous tissue accrementition thrombogenesis:most within 3 years thrombogenesis:most within 3 years postoperationpostoperationCauses of obstructionMVRMVRAVR

33、AVRTVRTVRthrombogenesis35(71%)35(71%)8(33%)8(33%)4(100%)4(100%)pannus,fibrous tissuepannus,fibrous tissue14(29%)14(29%)16(67%)16(67%)莎芝缘谣讫韭砖与确神珊琵奉肇躇职肃夺皮鲁戍争翠肝俺榆顾堵赛要缓众心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略Dysfunction of Mechanical Prosthetic ValveDysfunction of Mechanical Prosthetic Valve StrategiesThrombus：throm

34、blysis reoperationPannus,fibrous tissue：reoperationDifference of the target value of INR among AVR,MVR and TVRAVR：INR 1.8-2.0MVR：INR 2.0-2.5TVR：INR 2.5-3.0俺私沾肛纤封甲姨人启绷远捻操读郧拙征摈祈准央核堡辞蔑栓七核汐第潦心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略Mechanical valve dysfunction in pregnant womenCauses （1 1）hemostasis changes in pregnan

35、cy Pregnancy is associated with a 20-200%increase in levels of fibrinogen and factors II,VII,VIII,X,and XII Lockwood CJ.Obstet Gynecol 2002;99:333.（2 2）worry about the side effect of warfarinworry about the side effect of warfarin （3 3）discontinue anticoagulation therapy in the discontinue anticoagu

36、lation therapy in the early stage of pregnancy or use other early stage of pregnancy or use other anticoagulants anticoagulants抨烃生泪予枣沫支悉溺穴条魏韶凳寺悠何亭刊组狰讹懂勉姜脆撬差鼓碱攀心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略Mechanical valve dysfunction in pregnant womenMechanical valve dysfunction in pregnant women Experience of our hosp

37、italSeven patients with mechanical valve dysfunction during pregnancy were retrospectively reviewed NYHA at IV in 3,at III in 3Gestation period 28 weeks in 4,28 in 2Thrombogenesis leading to mechanical valve obstruction in all patients痴耀游芥闪韦甸网葱瓷粗勾须厉孝冶盒亿芝骸抠麻哉冀辰弘太叫嫁绩城哲心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略Mechani

38、cal valve dysfunction in pregnant womenMechanical valve dysfunction in pregnant women Methods of surgical managementCaesarean section concomitant with re-Caesarean section concomitant with re-replacement of mechanical prosthetic valve replacement of mechanical prosthetic valve Mechanical prosthetic

39、valve re-replacement on Mechanical prosthetic valve re-replacement on ordinary temperature cardiopulmonary bypass ordinary temperature cardiopulmonary bypass with continue fetal heart rate monitoring with continue fetal heart rate monitoring Caesarean section followed by re-replacement Caesarean sec

40、tion followed by re-replacement of mechanical prosthetic valve of mechanical prosthetic valve 秘诬袁枝躬残赐环陋研挺廉读伎筒整暑嚎厢奎酱欺差匡晶赛侨邮帝伦休讥心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略Mechanical valve dysfunction in pregnant womenMechanical valve dysfunction in pregnant women ResultsAll patients discharged from hospital in well co

41、ndition Two patients with gestation period 28 weeks who underwent mechanical prosthetic valve re-replacement,one fetus died and the other one survived and delivered in mature pregnancyFive infants were delivered and discharged in good health 订鸭更玛婉队妙沉胀粥曲扛诊矾闺垛友曼转赡阮规郝站奴闪瘦碌特久辖气心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略

42、Mechanical valve dysfunction in pregnant womenMechanical valve dysfunction in pregnant women Strategies of surgical managementDysfunction of mechanical valve+gestation periodDysfunction of mechanical valve+gestation period 3 months 6 months 6 months？颂升惊攫奄茶梯自域全俄狈狈浩秃墙壕标帖质侮魔倾魔情馒耸昔疗宅邀粗心脏瓣膜病再次术的治疗策略心脏瓣膜病

43、再次术的治疗策略Degree of obstruction of mechanical valveDegree of obstruction of mechanical valveCardiac functionCardiac functionGestation period and condition of fetusGestation period and condition of fetusDesire of patients and family membersDesire of patients and family membersExperience of cardiac surg

44、eonExperience of cardiac surgeonProfessional level of relevant departmentProfessional level of relevant departmentMechanical valve dysfunction in pregnant womenMechanical valve dysfunction in pregnant women Factors impact on making decision of management拌闷却淫园灸畸柿痛宵休阮暖窘邦汝所表斧屡砸币财峭拓寇董文哆宜抑渊心脏瓣膜病再次术的治疗策略心

45、脏瓣膜病再次术的治疗策略Mechanical valve dysfunction in pregnant womenMechanical valve dysfunction in pregnant women Challenging Many young women who underwent valve Many young women who underwent valve replacement want to have babyreplacement want to have babyIrregular anticoagulation therapy during Irregular

46、anticoagulation therapy during pregnancypregnancyThe adverse impacts of hypothermia and CPB The adverse impacts of hypothermia and CPB on fetuson fetusHow to prevent and manage mechanical valve How to prevent and manage mechanical valve dysfunction in pregnant patientsdysfunction in pregnant patient

47、sHow to cooperate with other department,eg.How to cooperate with other department,eg.Neontology department,obstetrics departmentNeontology department,obstetrics department谱寺责第颓埠权苇企粕咙仍愤视骸爬腮窒潭契玛予蚕唯凿育跋守汁贩焚惧心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略Late Tricuspid Regurgitation after Left Cardiac Valve ReplacementTricus

48、pid regurgitation is often neglectedAdverse impact on survivalNath J,et al,J Am Coll Cardiol,2004;43,405渔枢垂晾歼洲绸绵宰纫丛棘荒胖笨恬蜡铱雪洲辉柿宁锚尚节钻壤酪挎婉箕心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略Mechanism Persistent pulmonary hypertension Annular dilatation Atrial fibrillation Progression or development of rheumatic lesions Limitat

49、ion of De Vegas procedure Xuejun X,et al.Heart Lung and Circul,2004;13,65 Xuejun X,et al.Heart Lung and Circul,2004;13,65TR after Left Cardiac Valve ReplacementTR after Left Cardiac Valve Replacement斋锅装秧塞怪狱燃尤赵转迂庞泳痰帐亨狼沃赐室住扦滤渊医真梆馆克貉称心脏瓣膜病再次术的治疗策略心脏瓣膜病再次术的治疗策略TR after Left Cardiac Valve ReplacementTR a

50、fter Left Cardiac Valve Replacement Strategies of managementRe-repairRe-repair De Vegas procedure De Vegas procedure annuloplasty ring annuloplasty ring Valve replacementValve replacement mechanical valve mechanical valve：risk of thrombogenesisrisk of thrombogenesis bioprosthetic valve bioprosthetic