《瓣膜病的手术时机选择》由会员分享，可在线阅读，更多相关《瓣膜病的手术时机选择（25页珍藏版）》请在金锄头文库上搜索。
1、瓣膜病的手术时机选择福建医科大学附属协和医院心内科 陈良龙Fighting CVDIndications for Aortic Valve Replacement in pts with AS Class I AVR is indicated for symptomatic patients with severe AS (LOE: B) AVR is indicated for patients with severe AS undergoing CABG (LOE: C) AVR is indicated for patients with severe AS undergoing sur
2、gery on the aorta or other heart valves. (LOE: C) AVR is recommended for patients with severe AS and LV systolic dysfunction (EF 0.50). (LOE: C)Class IIa AVR is reasonable for pts with moderate AS undergoing CABG or surgery on the aorta or other heart valves (LOE: B)Indications for Aortic Valve Repl
3、acement in pts with AS Class IIb AVR may be considered for asymptomatic pts with severe AS and abnormal response to exercise (e.g., development of symptoms or asymptomatic hypotension). (LOE: C) AVR may be considered for adults with severe asymptomatic AS if there is a high likelihood of rapid progr
4、ession (age, calcification, and CAD) or if surgery might be delayed at the time of symptom onset. (LOE: C)Indications for Aortic Valve Replacement in pts with ASClass IIb AVR may be considered in pts undergoing CABG who have mild AS when there is evidence, such as moderate to severe valve calcificat
5、ion, that progression may be rapid. (LOE: C) AVR may be considered for asymptomatic pts with extremely severe AS (AVA 0.6 cm2 , MPG 60 mm Hg, and jet velocity 5.0m/sec) when the patients expected operative mortality is 1.0% (LOE: C)Indications for Aortic Valve Replacement in pts with AS Class III AV
6、R is not useful for the prevention of sudden death in asymptomatic patients with AS who have none of the findings listed under the class IIa/IIb recommendations. (LOE: B)Clinical follow-up, patient education, risk factor modification, annual echoSymptoms?Exercise testLV ejection fractionSevere valve
7、 calcification, rapid progression, and/or expected delays in surgeryYesLess than 0.50NormalNoPreoperative coronary angiographyClass Aortic Valve ReplacementClass bClass Class Class bSymptoms BPNormalEquivocalYesNoUndergoing CABG or other heart surgery?Severe Aortic StenosisAVA less than 1.0 cm2Vmax
8、greater than 4 m/sMean gradient 40 mmHg Re- evaluationIndications for Aortic Valve Replacement in pts with ARClass I AVR is indicated for symptomatic pts with severe AR irrespective of LV systolic function. (LOE: B) AVR is indicated for asymptomatic pts with chronic severe AR and LV systolic dysfunc
9、tion (EF 0.50) at rest. (LOE:B) AVR is indicated for pts with chronic severe AR while undergoing CABG or surgery on the aorta or other heart valves. (LOE: C)Class IIa AVR is reasonable for asymptomatic pts with severe AR with normal LV systolic function (EF 0.50) but severe LV dilatation (EDD 75 mm
10、or ESD 55 mm) (LOE: B)Indications for Aortic Valve Replacement in pts with ARClass IIb AVR may be considered in pts with moderate AR while undergoing surgery on the ascending aorta. (LOE: C) AVR may be considered in pts with moderate AR while undergoing CABG. (LOE: C) AVR may be considered for asymp
11、tomatic pts with severe AR and normal LV systolic function at rest (EF 0.50 ) when EDD 70 mm or ESD 50 mm, when there is evidence of progressive LV dilatation, declining exercise tolerance, or abnormal hemodynamic responses to exercise .(LOE: C)Indications for Aortic Valve Replacement in pts with AR
12、Class III AVR is not indicated for asymptomatic patients with mild, moderate, or severe AR and normal LV systolic function at rest (EF 0.50) when EDD 70 mm or ESD 50 mm. (LOE: B)Class IClass IIbClinical eval every 6 moEcho every 6 moChronic Severe Aortic RegurgitationNoClinical evaluation + EchoSymp
13、toms?YesEquivocalExercise testLV function?EF borderline of uncertainNormal EFEF of 50% or lessRVG or MRILV dimensions?SD 45-50 mm or DD 60-70 mmNo symptomsSD 50-55 mm or DD 70-75 mmSD 45 mm or DD 60 mmSymptomsStable?YesClinical eval every 6 moEcho every 12 moNo . or initial studyReevaluate and Echo
14、3moStable?Stable?Yes No . or initial studyReevaluate and Echo 3moClinical eval every 6-12 moEcho every 12 moYesReevaluationConsider hemodynamic response to exerciseClass IIa SD 55 mm or DD 75 mmAbnormalNormalClass IAVRClass IIndications for Percutaneous Mitral Balloon ValvotomyClass I PMBV is effect
15、ive for symptomatic pts (NYHA functional class II, III, or IV), with moderate or severe MS and valve morphology favorable for it in the absence of LA thrombus or moderate to severe MR. (LOE: A) PMBV is effective for asymptomatic pts with moderate or severe MS and valve morphology favorable for it wh
16、o have pulmonary hypertension (PPP 50 mm Hg at rest or 60 mm Hg with exercise) in the absence of LA thrombus or moderate to severe MR. (LOE: C)Class IIa PMBV is reasonable for pts with moderate or severe MS* who have a nonpliable calcified valve, are in NYHA functional classIIIIV, and are either not candidates for surgery or are a
