《缺血性二尖瓣反流》PPT课件
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• Concomitant revascularization during mitral valve surgery is associated with improved short-term and long-term outcomes
.
9
Concomitant revascularization during mitral valve surgery is associated with improved
• A new pansystolic murmur is heard loudest at the cardiac apex
• Electrocardiography usually confirms an inferior or posterior MI • Chest radiography demonstrates pulmonary edema, which
ACUTE MITRAL REGURGITATION（MR） Introduction
• Mild to moderate chronic MR is found in 15% to 45% of patients after AMI，usually transient and asymptomatic
revascularization following acute postinfarction mitral regurgitation. ([A] From Chevalier P, Burri H,Fahrat F, et al. Perioperative outcome and
blood supply to the posteromedial papillary muscle from the PD
.
5
Prevalence of mitral regurgitation (MR) with respect to posterior papillary muscle (PM) perfusion pattern and inferior myocardial
short-term and long-term outcomes
Kaplan-Meier graphs demonstrating (A) perioperative and (B) 15-year actuarial survival benefit in patients undergoing concomitant coronary
occasionally is localized to the right upper lobe
.
7
Diagnosis
.
8
ห้องสมุดไป่ตู้
Treatment
• Prompt diagnosis with immediate initiation of aggressive medical therapy is vital until emergent surgical intervention can be performed
infarction (MI).
Paolo Voci et al. Circulation. 1995;91:1714-1718
.
6
Copyright © American Heart Association, Inc. All rights reserved.
Diagnosis
• Immediate pulmonary edema, hypotension, and,in some cases, cardiogenic shock
• Diagnosed between 2 to 7 days after AMI，the median time to papillary muscle rupture is approximately 13 hours
.
4
Pathophysiology
• Following AMI,in combination with changes in LV shape and regional wall function, results in acute MR
• Acute MR secondary to papillary muscle rupture is a lifethreatening complication with a poor prognosis
• Occurs in 0.25% of patients following AMI and represents up to 7% of patients in cardiogenic shock following AMI
✓ Rupture of the left ventricular free wall (0.52%) ✓ Papillary muscle (0.26%) ✓ Ventricular septum (0.17%)
.
2
Survival after Mechanical complication
.
3
• Even slight modifications of LV geometry caused by regional wall-motion abnormality may contribute to the increased frequency of MR after AMI
• Commonly following an inferior MI，owing to the single
ISCHEMIC MITRAL REGURGITATION IN PATIENTS WITH ACUTE MYOCARDIAL
INFARCTION
急性心肌梗死合并缺血性二尖瓣反流
.
1
Mechanical Complications of Acute Myocardial Infarction
• Primary PCI as the principal reperfusion strategy following STEMI, the incidence of mechanical complications has reduced significantly to less than 1%
.
9
Concomitant revascularization during mitral valve surgery is associated with improved
• A new pansystolic murmur is heard loudest at the cardiac apex
• Electrocardiography usually confirms an inferior or posterior MI • Chest radiography demonstrates pulmonary edema, which
ACUTE MITRAL REGURGITATION（MR） Introduction
• Mild to moderate chronic MR is found in 15% to 45% of patients after AMI，usually transient and asymptomatic
revascularization following acute postinfarction mitral regurgitation. ([A] From Chevalier P, Burri H,Fahrat F, et al. Perioperative outcome and
blood supply to the posteromedial papillary muscle from the PD
.
5
Prevalence of mitral regurgitation (MR) with respect to posterior papillary muscle (PM) perfusion pattern and inferior myocardial
short-term and long-term outcomes
Kaplan-Meier graphs demonstrating (A) perioperative and (B) 15-year actuarial survival benefit in patients undergoing concomitant coronary
occasionally is localized to the right upper lobe
.
7
Diagnosis
.
8
ห้องสมุดไป่ตู้
Treatment
• Prompt diagnosis with immediate initiation of aggressive medical therapy is vital until emergent surgical intervention can be performed
infarction (MI).
Paolo Voci et al. Circulation. 1995;91:1714-1718
.
6
Copyright © American Heart Association, Inc. All rights reserved.
Diagnosis
• Immediate pulmonary edema, hypotension, and,in some cases, cardiogenic shock
• Diagnosed between 2 to 7 days after AMI，the median time to papillary muscle rupture is approximately 13 hours
.
4
Pathophysiology
• Following AMI,in combination with changes in LV shape and regional wall function, results in acute MR
• Acute MR secondary to papillary muscle rupture is a lifethreatening complication with a poor prognosis
• Occurs in 0.25% of patients following AMI and represents up to 7% of patients in cardiogenic shock following AMI
✓ Rupture of the left ventricular free wall (0.52%) ✓ Papillary muscle (0.26%) ✓ Ventricular septum (0.17%)
.
2
Survival after Mechanical complication
.
3
• Even slight modifications of LV geometry caused by regional wall-motion abnormality may contribute to the increased frequency of MR after AMI
• Commonly following an inferior MI，owing to the single
ISCHEMIC MITRAL REGURGITATION IN PATIENTS WITH ACUTE MYOCARDIAL
INFARCTION
急性心肌梗死合并缺血性二尖瓣反流
.
1
Mechanical Complications of Acute Myocardial Infarction
• Primary PCI as the principal reperfusion strategy following STEMI, the incidence of mechanical complications has reduced significantly to less than 1%