Treatment of valvular heart disease: valvuloplasty

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Abstract: the Shanghai Yuanda Cardiothoracic Hospital experts pointed out that the annuloplasty surgery is not only for anatomical recovery

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Abstract: the Shanghai Yuanda Cardiothoracic Hospital experts pointed out that the annuloplasty surgery is not only for anatomical recovery or heart valve annulus, and the more important purpose is to improve and restore the normal function of the heart valve and allow the heart to normal operation.

For all the different surgical valvuloplasty valvular heart disease with different repair methods, including leaflet resection or repair, valve tendon adhesions, chordae shortening or transplantation, artificial annulus annulus and narrow annulus deformity, it is also known as the "comprehensive valve plasty".

Shanghai Yuanda Cardiothoracic Hospital experts pointed out that the annuloplasty surgery is not only for anatomical recovery or heart valve annulus, and the more important purpose is to improve and restore the normal function of the heart valve and allow the heart to normal operation. The ultrasonic technique is very accurate and sensitive to the function of the heart valve. The technique of transesophageal echocardiography provides the technical support for the development of the valve forming operation, which makes the valve forming technology become more and more perfect.

Aortic valvuloplasty

Acquired aortic valve disease is also the most common rheumatic disease, often with mitral valve disease at the same time, followed by senile degeneration and infective endocarditis, etc.. Aortic valve regurgitation can be caused by the enlargement of the valve ring, the flap of Ye Zenghou, the deformation and the limitation of motion. There are more opportunities for acute traumatic incomplete closure, and rheumatic aortic regurgitation should be determined according to the pathological changes. All of these lesions can be treated by aortic valvuloplasty.

The main methods of aortic valvuloplasty include aortic valve constriction, partial resection of the leaf flap, and the incision of the border and the margin of the flap.

Mitral valvuloplasty

The sleeve type valve structure of mitral valve provides anatomical basis, good mitral valve according to statistics, only 69% mitral valve insufficiency can be performed valvuloplasty. Mitral regurgitation including congenital mitral insufficiency, rheumatic mitral regurgitation without flap contracture, severe calcification of ischemic mitral regurgitation, degenerative mitral regurgitation.

Indications and contraindications of mitral valvuloplasty in patients with mitral valve repair: no calcification of the diseased valve should be considered first, mainly based on the condition of the lesion rather than on the cause of the disease, the patient's condition, and age. The exploration of the preoperative examination or intraoperative findings of valve calcification and hardening, flap adhesions, chordae shortening and fusion, or leaflet damage 1 / 4 above, should be regarded as forming a contraindication for surgery with aortic lesions; at the same time, the need for aortic valve replacement patients, Shanghai Yuanda Cardiothoracic Hospital experts remind: the mitral valve treatment should be cautious; left ventricular function damage, it is difficult to long time ischemia tolerance of patients, should be timely for valve replacement surgery.

Three tricuspid valvuloplasty

The three cusp is the atrioventricular valve of the right ventricle, and it is well tolerated in the patients with incomplete closure. Three tricuspid regurgitation include: three tricuspid valve secondary to mitral valve disease and aortic closure, three Ebstein's malformation (Ebstein malformation), three congenital tricuspid stenosis or closure of three tricuspid insufficiency, secondary to congenital heart disease insufficiency. If the enlargement of the valve ring and the small flow rate of the valve ring, the DeVega method can be used to make the valve ring plasty. The Carpentier ring or Duran artificial valve ring plasty should be used in three patients with high enlargement of the tricuspid valve ring, large discharge of the three cusp and severe pulmonary hypertension.

Three of the downward displacement of the tricuspid valve (Ebstein) is a complex congenital heart disease. Shanghai Yuanda Cardiothoracic Hospital pediatric heart center uses three Ebstein's malformation (Ebstein malformation) anatomic correction method to treat severe three Ebstein's malformation, surgical effect of patients after recovery of heart function after treatment is good, normal life and learning.

Pulmonary valvuloplasty

Complex congenital heart disease with pulmonary valve stenosis for outflow tract transannular patch, can be used or prepared for pericardial valve pulmonary valve homograft valved forming leaves, and is conducive to the recovery of heart function; pulmonary valve junction adhesion, can for commissurotomy; and the pulmonary valve ring expansion causes the insufficiency, can flap ring constriction. The pediatric heart center of Shanghai Yuanda Cardiothoracic Hospital was treated with the above methods in the treatment of complex congenital heart disease with pulmonary valve insufficiency.

 

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