复旦大学：《内科学 Internal Medicine MBBS》课程教学资源（课件讲稿）循环系统_Valvular Heart Disease

Valvular heart disease Zhongshan Hospital, Fudan University Shanghai Institute of Cardiovascular Diseases Xianhong Shu, MD, PhD 复旦大学附属中山医院 Zhongshan Hospital, Fudan University @

Valvular Heart Disease Zhongshan Hospital, Fudan University Shanghai Institute of Cardiovascular Diseases Xianhong Shu, MD, PhD

Introduction o remarkable changes in the evaluation and management of patients with valvular heart disease Advances in surgical approaches and interventional cardiology procedures have improve patient's outcomes 复旦大学附属中山医院 Zhongshan Hospital, Fudan University @

Introduction • remarkable changes in the evaluation and management of patients with valvular heart disease • Advances in surgical approaches and interventional cardiology procedures have improve patient’s outcomes

Valvular heart disease Mitral Aortic Stenosis regurgitation Re Tricuspid Pulmonary 复旦大学附属中山医院 Zhongshan Hospital, Fudan University @

Valvular heart disease Mitral Aortic Tricuspid Pulmonary Stenosis Regurgitation

Diagnosis Etiology and pathology Pathophysiology e Clinical manifestation ° Physical Findings e Laboratory Examination Differential Diagnosis Treatment 复旦大学附属中山医院 Zhongshan Hospital, Fudan University @

Diagnosis • Etiology and pathology • Pathophysiology • Clinical manifestation • Physical Findings • Laboratory Examination • Differential Diagnosis • Treatment

Key Concepts o Echocardiography remains the gold standard for diagnosis and follow up patients with valvular heart disease. Stenotic valvular lesions can be monitored clinically until symptoms appear ● Regurgitant valvular lesions require careful echocardiographic monitoring for left ventricular function and may require surgery even if no symptoms are present 复旦大学附属中山医院 Zhongshan Hospital, Fudan University @

Key Concepts • Echocardiography remains the gold standard for diagnosis and follow up patients with valvular heart disease. • Stenotic valvular lesions can be monitored clinically until symptoms appear • Regurgitant valvular lesions require careful echocardiographic monitoring for left ventricular function and may require surgery even if no symptoms are present

Medical therapy aims at control of symptoms Surgery is the treatment for most symptomatic lesions or for lesions causing left ventricular dysfunction even in the absence of symptoms. 复旦大学附属中山医院 Zhongshan Hospital, Fudan University @

• Medical therapy aims at control of symptoms. • Surgery is the treatment for most symptomatic lesions or for lesions causing left ventricular dysfunction even in the absence of symptoms

MITRAL STENOSIS (MS) 复旦大学附属中山医院 Zhongshan Hospital, Fudan University @

MITRAL STENOSIS ( MS )

ETIOLOGY AND PATHOLOGY ° Rheumatic fever o Two-thirds are female o 25% of all patients have pure MS o 40% have combined Ms and mitral regurgitation (MR) the incidence of ms is declining A major problem in tropical climates and developing countries ③氢思大学时属中山院@

ETIOLOGY AND PATHOLOGY • Rheumatic fever • Two-thirds are female • 25% of all patients have pure MS • 40% have combined MS and mitral regurgitation (MR) •the incidence of MS is declining • A major problem in tropical climates and developing countries

Rheumatic fever results in four forms of fusion leading to stenosis: Commissural Cuspal Chordal Combined o mitral valve cusps fuse at the their edges o fusion of the chordae tendineae results in thickening and shortening of these structures 复旦大学附属中山医院 Zhongshan Hospital, Fudan University @

• Rheumatic fever results in four forms of fusion leading to stenosis:  Commissural  Cuspal  Chordal  Combined • mitral valve cusps fuse at the their edges •fusion of the chordae tendineae results in thickening and shortening of these structures

Calcification of the valve immobilizes the leaflets and narrows the orifice lead to narrowing of the valve(fish mouth) e dilated left atrium (LA) o Thrombus frequently arise from LA in patients with atrial fibrillation(AF) Other causes: congenital,- malignant carcinoid, SLE, Amyloid, etc. 复旦大学附属中山医院 Zhongshan Hospital, Fudan University @

• Calcification of the valve immobilizes the leaflets and narrows the orifice •lead to narrowing of the valve (fish￾mouth) • dilated left atrium (LA) • Thrombus frequently arise from LA in patients with atrial fibrillation (AF) • Other causes: congenital, malignant carcinoid, SLE, Amyloid, etc