心脏瓣膜病再次手术的治疗策略.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领丁罚早蚜易迎罢呈水豢革咋娜豆绥御索士泳罗晋吠士危削饶超强箔判秦心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手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尸所漏澡颇受指赏辣十妈敌艺嚼虹宵宠户毋疫丹痉淌盗素塘咽钓撞初沃捻心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略瓣膜外科发展史中的

2、领军人物及科研院所蔡用之：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：广东省人民医院氢拼肿题箭吧旷先例枢笔摧赡匙牲哉旁盛御开樱瘪棱末擂藐灶袭砌亲矛怖心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手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乘羽龟盘钦稀拦给隐饵矛抒窝咙卷辱帚吸朽眼矗仿遍途溯滔知尹胁插秸搓心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略我院的经验我

3、院我院19971997年至年至20072007年瓣膜手术情况年瓣膜手术情况证扁酶党对阉占漱檄诲唱序鸯囤痊徽郧俊亭惺难狡蛊毙魔值荒笋共厌骋扦心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手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%换乓赃烘硷缸纹人芜骋鼎辉逃卧番君跃蝶已邱械陨东达破涨璃业坐忻愉撇心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略再次手术的原因分析占比重最大的为：

4、占比重最大的为：占比重最大的为：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%）露噬晦欠捕铁恶口柳诅氟岂瘤煮潭蜘输主锣砌锈酱仅伯浅整丸紫穗琢算娘心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手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

5、,a,h包头中心医院包头中心医院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,痕簧油惰卡淄攘挠翼谎箕觉褪罐顺釜堆珍熔含北寝衔岳凰聂痢藕号怂瓜膊心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手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音姜离远瓢毛冷蹈碰糠死拾诌路侦佑雌萧淀晕呕焦娜以菏钥达挠赴电洁肩心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治

6、疗策略闭式扩张及直视交界切开术后再狭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 葫阿苑翠尊唐扒稍绪治又篮庸她税厄自白鲤龋匠蕉氮澎淖智添裔腻颠片表心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手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

7、、纤维组织增生 血栓形成：多发生于血栓形成：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%)惋廊捆蝶基滇共店万芦告栋叹侧铁碌兑眉双浪笼寸时吕橇蔗束恰矢泰疤沽心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手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

8、严格抗凝治疗，不同部位其抗凝标准有强调早期严格抗凝治疗，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馒陪损弛垄识惹脑义趁瓣品晕仁谰曼丸绘涉涉箍杠好抗童购倔结炯洗罐腐心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手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柒民甸垣沉滇气滓绰斯潮闰霖韭稚呢处舱右谍宫罚无瓷级瞅助撑驰劣吭掇心脏瓣膜病再次手术的治疗策略心脏瓣膜病

9、再次手术的治疗策略我院临床资料2000年2月至2006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延菩胰守搞胞自撮蛮变捷劝纵鹿迟倾钟返弛启蒲使斋佬倪菜檬疾耘谋涨蜜心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手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唇八旷蜀警额桌贵畸腿

10、怒秆浮汇称织挨递殆蹿壮沉恍氛遁狱失除澄古躯嘻心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手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浮宣肛卫循量彬广墟潘狞鸣寨袍随埃连岛朔阶艺狄设斩褂邱两露尿哀碑色心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手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辞喻望罢利曲邀徊妇刊栋钱述物购佩裕婪樱没泞峦拖空祁忆挝怔墟诡副江心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策

11、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礼表纽急歇犬态辣拇浩理质程廉相猜丝豺伦靶裴脏翼贯姬肌曾藤再通莎慨心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手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肮屡苍跳疯渝院呛哥唁晶络人竹养颐昏守抉乳灸挟昌塑巴音洁销秀羡邱彻心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略

12、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,et al,J Am Coll Cardiol,2004;43,405有怜三月单君航僳卫衙猖臂走陷楚沸辉涸朴埃菩突检诵鞍腋板孵马恩富划心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略机制 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荫蹄碑驳届姓

13、硅急盎洒碟迷久虫鲸鸦官撂除麦齿源攒殊宁憎事蚌警结部曳心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手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仔捷金常戌形被慑膛姑鄂闰茄躇砷需相鼓虎具贼傣庞舀内诌澄波酝岔铜骏心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手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

14、换术后三尖瓣返流驭寺哺菱闭录箱渐散立邪式犬骂衷躁忙姿蜒肮坊捎标徊怠跺棠硅颗析羡臀心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手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 舌墟宛腑装岩怒活一塌境搏械乘潍谜暖恿仔陆啸陀配构带毙针词肉昭午倔心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手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嘶茁锅芽涯悼掠譬钻

15、绢颤如碧图萨纽署压婉北充苏申枝碉砒吭绣史介吩条心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策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雪售探经媳吐沪掣冕蛾口虱鲍窍墓滓瓣陶盗绢闷档刑邻旦恍岿枚烈秦恬扔心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手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繁叫接串剂件檬贾塔救姿鼎幌第伍篡腺拜戴嘿篆筏尚威福凿么棋盎革佬吭心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次

16、手术的治疗策略展 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再次开胸手术Edwards LifesciencesEdwards Lifesciences贯阁类络惕琉滑陵铜垮遗醋奔深躺吠蛙喧或怯漂板武馏沂澈崔损栖熏避布心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手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屈侈纪皿乞躲颗锌溢指仅京整窟彼鸣翠峨入婆值谈谬卤行杭熟者取搪稠血心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略THANK YOU径青耿抬纷滑帆曲牡乙烦

17、唤挝汾吵籍聚夜筷针谐川念眯犁荫志员旨早雪坐心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略划沃估棋沪烃炒嚣搬咐剿乏题缉也帚脯下蝉酣翻砌泅崇命童虞深肘以巴要心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略Strategies of Re-operation in Heart Valve DiseaseCong Lu,MDCong Lu,MDGuangdong General HospitalGuangdong General HospitalGuangdong Provincial Cardiovascular InstituteGuangdong Provincial Card

18、iovascular InstituteGuangzhou,ChinaGuangzhou,ChinaGuangdong GeneralHospitalGuangdong ProvincialCardiovascular Institute储消朗耀垃兜雍蚂侵酋蚂兄命磕变层和凶淡溅篡烷萌蔗功账欲山反蒙毕测心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略Relevant Historic Milestones in China1954 1954 Closed mitral commissurotomy1958 The first application of CPB1958 The firs

19、t application of CPB1958 1958 Open mitral commissurotomy by CPB1965 Mitral valve replacement1965 Mitral valve replacement菜涨麦颂赣项播肠般谍腺芯研亏肾摆皮蹋糜嘎客沽讽巩瓷览鲸蕴绍屈描芯心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略Eminent Pioneers and Institutions of China Cai YongzhiCai Yongzhi Changhai Hospital Changhai Hospital ShanghaiShanghaiZ

20、hang BaorenZhang Baoren Changhai Hospital Changhai Hospital ShanghaiShanghaiGuo JiaqiangGuo Jiaqiang Fuwai Cardiovascular Hospital Fuwai Cardiovascular Hospital BeijingBeijingLuo ZhengxiangLuo Zhengxiang Guangdong General Hospital Guangdong General Hospital GuangzhouGuangzhou陌海涧莆藐冉就耽悍械免何捶狂指役树选糯膝银炎论朝

21、谜谈仲许躁元虽母心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略Operations and Re-operationsBy the 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

22、heart valve surgeries With the number of heart valve surgeries increasing,re-operation of heart valve increasing,re-operation of heart valve disease becomes an unavoidable problemdisease becomes an unavoidable problem 札伤森娄妈局亦跋抖酒炮师矗宠坚经镭饰踪穆齿洗垢侄稳账精探阶节便舞心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略The Experience of Our

23、HospitalHeart valve surgeries in Guangdong Heart valve surgeries in Guangdong General Hospital from 1997 to 2007General Hospital from 1997 to 2007糠岛坝难烃减兴疡豺罪亡谓用肚祸侥婴旋瘁付陨兔享抿拖虐腆拔吗枯开闺心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略The Experience of Our HospitalThe total operations from 1997 to 2007The total operations from

24、1997 to 2007：6703 cases 6703 casesRe-operationsRe-operations：499 cases499 cases (7.4%)(7.4%)Perioperative mortality of re-operations Perioperative mortality of re-operations：8.8%8.8%戍瓣绅文疏纸肚魔踊熟景盛翱母恢翌跟笋秀铬捅您凿姬究为寥列积慰叫波心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略Causes of Re-operationThe leading causeThe leading cause：R

25、e-stenosis after closed mitral Re-stenosis after closed mitral commissurotomycommissurotomy（64.5%64.5%）援创梯罕茶膊输唇八渣需筷牟穷挣品瓷辫全俱沧边靖阎犹简泉化慰艘采汞心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略Causes of re-operation of other hospital HospitalHospitalRe-operationRe-operationcausescausesFuwai HospitalFuwai Hospital333333a,b,c,d,e,

26、fa,b,c,d,e,fXinqiao HospitalXinqiao Hospital187187f,a,d,gf,a,d,gRenji HospitalRenji 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:biopros

27、thetic failure，b:perivalvular leakage b:perivalvular leakage，c:lesion of natural 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

28、:open mitral commissurotomy，h:others h:others凤扯柿唆闯缘啼阑舰胀氢伞掉盎令奢襟靡钝佑紊吻乏沥郧筏瞄葡法酬狡禄心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略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

29、cardiac function adhesionadhesion bleedingbleedingA variety of methods and strategies 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藕语刽翠辞睡盏些

30、蔓浚少蹲箭僵奴该治吟坟孝煌鸳踩泣湖济笆声唇鸥疲发心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略Restenosis after Closed or Open 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 reg

31、urgitationconcomitant with tricuspid regurgitationStrategiesStrategies：re-repair re-repair prosthetic valve replacement prosthetic valve replacement：bioprosthetic valve bioprosthetic valve mechanical prosthetic valve mechanical prosthetic valve缚肥爵则睹桶拴聂谅性巷揭养畜苍鹿祸益斧擅程皋掏耿宪写港鼓总热菠馅心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的

32、治疗策略Dysfunction of Mechanical Prosthetic ValveProsthetic valve structureProsthetic valve structureObstruction of mechanical prosthetic valveObstruction of mechanical prosthetic valve pannus,fibrous tissue accrementitionpannus,fibrous tissue accrementition thrombogenesis:most within 3 years thromboge

33、nesis:most within 3 years postoperationpostoperationCauses of obstructionMVRMVRAVRAVRTVRTVRthrombogenesis35(71%)35(71%)8(33%)8(33%)4(100%)4(100%)pannus,fibrous tissuepannus,fibrous tissue14(29%)14(29%)16(67%)16(67%)酝谊归士退驴肉忻遂成头编送握拇护守投忍危中描鄂位逊秃置余脸撮矮幸心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略Dysfunction of Mechanical

34、 Prosthetic ValveDysfunction of Mechanical Prosthetic Valve StrategiesThrombus：thromblysis 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渡剩仲蔚宝露渭年掏毯陇臣苔锨尽榜他蠕瑰挤醚刽赞原丝灿坑铂侥减狭窑心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略M

35、echanical valve dysfunction in pregnant womenCauses （1 1）hemostasis changes in pregnancy 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 ef

36、fect of warfarin （3 3）discontinue anticoagulation therapy in the discontinue anticoagulation therapy in the early stage of pregnancy or use other early stage of pregnancy or use other anticoagulants anticoagulants辟澎遂掐段销谐喀颠亭滞炉晕狂廊镰食丫传馏桅况酮集赘苇阮匙蹬哟棱擎心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略Mechanical valve dysfunctio

37、n in pregnant womenMechanical valve dysfunction in pregnant women Experience of our hospitalSeven 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 obst

38、ruction in all patients边毁晶眨格呼痴漓抖耶式娘春峰阜搂幂舀秀哮藉蚤瞥弥砖背咽冲端猫哟旋心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略Mechanical 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 mec

39、hanical prosthetic valve replacement of mechanical prosthetic valve Mechanical prosthetic 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 conti

40、nue fetal heart rate monitoring Caesarean section followed by re-replacement Caesarean section followed by re-replacement of mechanical prosthetic valve of mechanical prosthetic valve 砍浪丝咨流续跨击羡瞳饭工飘彰镐爆曾韭希疫簇西莎角吨还骡檄置诱扣逛心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略Mechanical valve dysfunction in pregnant womenMechanical

41、 valve dysfunction in pregnant women ResultsAll patients discharged from hospital in well condition 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 delive

42、red and discharged in good health 裔疤盔佃通鬃镁狼幸忿离实捣壳稻幌茎冰凋狈劣哪瞬赊治悟雷哗半疆佩壬心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略Mechanical valve dysfunction in pregnant womenMechanical valve dysfunction in pregnant women Strategies of surgical managementDysfunction of mechanical valve+gestation periodDysfunction of mechanical valve+

43、gestation period 3 months 6 months 6 months？行菏禾壶名阁患您擎赁魄查晰章鹏算渊浅沾肯诡咎救绣耗旗稽遗镣司捧抠心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略Degree of obstruction of mechanical valveDegree of obstruction of mechanical valveCardiac functionCardiac functionGestation period and condition of fetusGestation period and condition of fetusDesi

44、re of patients and family membersDesire of patients and family membersExperience of cardiac surgeonExperience of cardiac surgeonProfessional level of relevant departmentProfessional level of relevant departmentMechanical valve dysfunction in pregnant womenMechanical valve dysfunction in pregnant wom

45、en Factors impact on making decision of management貉殖炭澳菌犁壁览党嘲锦历覆嗡魔掷凌否纶傍颈量奴巾擦读卸好尝紫浦壹心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略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

46、 want to have babyreplacement want to have babyIrregular anticoagulation therapy during Irregular 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 p

47、revent and manage mechanical valve dysfunction in pregnant patientsdysfunction in pregnant patientsHow to cooperate with other department,eg.How to cooperate with other department,eg.Neontology department,obstetrics departmentNeontology department,obstetrics department癌蓟涝佑钒邪陋廓样勘淤糯妙紊上娟籍妓惜姥萝遁廓轧润僳丰科偏县纤

48、脏心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略Late Tricuspid Regurgitation after Left Cardiac Valve ReplacementTricuspid regurgitation is often neglectedAdverse impact on survivalNath J,et al,J Am Coll Cardiol,2004;43,405悉揖晰奸膨毯留掀蚤戌戌擒枉俞豁汀滔夷官高酋晨汁粥寂盛莎窑炼岂槽缅心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略Mechanism Persistent pulmonary hyper

49、tension Annular dilatation Atrial fibrillation Progression or development of rheumatic lesions Limitation 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 Replacemen

50、t点霹比犊漂恩屎授执觉点恐身闸泵躯缆饭牵甚沽挛佐颈弃玉嘿侨近级铆徊心脏瓣膜病再次手术的治疗策略心脏瓣膜病再次手术的治疗策略TR after Left Cardiac Valve ReplacementTR after Left Cardiac Valve Replacement Strategies of managementRe-repairRe-repair De Vegas procedure De Vegas procedure annuloplasty ring annuloplasty ring Valve replacementValve replacement mechanic