心脏瓣膜病手术时机

1、推荐级别：推荐级别：IIIa手术指征 (Indication of Operation)Guidelines on the management of valvular heart disease (version )BSA=体外表积；LV=左心室；LVEF=左心室射血分数；LVESD=左心室收缩末内径SPAP=肺动脉收缩压a推荐级别b证据程度推荐级别：推荐级别：IIb症状否是LVEF60%60%或或LVESD45mmLVESD45mm否是是是LVEF30%否新发生的AF或SPAP50mmHg否否否否药物难治型药物难治型持久性瓣膜修复的可能，且伴发疾病少持久性瓣膜修复的可能，且伴发疾病少持久性

2、瓣膜修复的可能性大，外科持久性瓣膜修复的可能性大，外科手术风险低，存在危险因素手术风险低，存在危险因素是是随访外科手术外科手术如果可能修复如果可能修复扩展的扩展的HF治疗治疗药物治疗药物治疗是Rosenhek R, Rader F, Klaar U, Gabriel H, Krejic M, Kalbeck D, Schemper M, Maurer G, Baumgartner H. Outcome of watchful waiting in asymptomatic mitral regurgitation. Circulation 2006;113:22382244.Montant P

3、, Chenot F, Robert A, Vancraeynest D, Pasquet A, Gerber B, Noirhomme P, El Khoury G, Vanoverschelde JL. Long-term survival in asymptomatic patients with severe degenerative mitral regurgitation: a propensity scorebased comparison between an early surgical strategy and a conservative treatment approa

4、ch. J Thorac Cardiovasc Surg ;138:13391348.重度二尖瓣关闭不全但为到达指南标准：早期手术 vs.保守治疗总体生存率，心血管生存率、脑血管生存率的比照Montant P, Chenot F, Robert A, Vancraeynest D, Pasquet A, Gerber B, Noirhomme P, El Khoury G, Vanoverschelde JL. Long-term survival in asymptomatic patients with severe degenerative mitral regurgitation: a propensity scorebased comparison between an early surgical strategy and a conservative treatment approach. J Thorac Cardiovasc Surg ;138:13391348.重度二尖瓣关闭不全但为到达指南标准：早期手术 、保守治疗并规那么随访、保守治疗未规那么随访总体生存率，心血管生存率、脑血管生存率的比照左房前后径90mm右房131*174