瓣膜病的手术时机选择

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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FightingCVDIndicationsforAorticValveReplacementinptswithASClassIAVRisindicatedforsymptomaticpatientswithsevereAS(LOE:B)AVRisindicatedforpatientswithsevereASundergoingCABG(LOE:C)AVRisindicatedforpatientswithsevereASundergoingsurgeryontheaortaorotherh

2、eartvalves.(LOE:C)AVRisrecommendedforpatientswithsevereASandLVsystolicdysfunction(EF0.50).(LOE:C)ClassIIaAVRisreasonableforptswithmoderateASundergoingCABGorsurgeryontheaortaorotherheartvalves(LOE:B)IndicationsforAorticValveReplacementinptswithASClassIIbAVRmaybeconsideredforas

3、ymptomaticptswithsevereASandabnormalresponsetoexercise(e.g.,developmentofsymptomsorasymptomatichypotension).(LOE:C)AVRmaybeconsideredforadultswithsevereasymptomaticASifthereisahighlikelihoodofrapidprogression(age,calcification,andCAD)orifsurgerymightbedelayedatthetimeofsymptom

4、onset.(LOE:C)IndicationsforAorticValveReplacementinptswithASClassIIbAVRmaybeconsideredinptsundergoingCABGwhohavemildASwhenthereisevidence,suchasmoderatetoseverevalvecalcification,thatprogressionmayberapid.(LOE:C)AVRmaybeconsideredforasymptomaticptswithextremelysevereAS(AVA0.6

5、cm2,MPG60mmHg,andjetvelocity5.0m/sec)whenthepatient’sexpectedoperativemortalityis1.0%(LOE:C)IndicationsforAorticValveReplacementinptswithASClassIIIAVRisnotusefulforthepreventionofsuddendeathinasymptomaticpatientswithASwhohavenoneofthefindingslistedundertheclassIIa/IIbrecomm

6、endations.(LOE:B)Clinicalfollow-up,patienteducation,riskfactormodification,annualechoSymptoms?ExercisetestLVejectionfractionSeverevalvecalcification,rapidprogression,and/orexpecteddelaysinsurgeryYesLessthan0.50NormalNoPreoperativecoronaryangiographyClassⅠAorticValveReplacement

7、ClassⅡbClassⅠClassⅠClassⅡbSymptoms↓BPNormalEquivocalYesNoUndergoingCABGorotherheartsurgery?SevereAorticStenosisAVAlessthan1.0cm2Vmaxgreaterthan4m/sMeangradient＞40mmHgRe-evaluationIndicationsforAorticValveReplacementinptswithARClassIAVRisindicatedforsymptomaticptswithsevereARir

8、respectiveofLVsystolicfunction.(LOE:B)AVRisindicatedforasympt