朱风琴,龙愉良,潘文志

• 1:徐汇区长桥街道社区卫生服务中心全科
• 2:复旦大学附属中山医院心内科

摘要(Abstract)：

老年退行性心脏瓣膜病的发病率与年龄呈正相关,随着医疗水平的提升,老龄化社会的瓣膜病主要表现在主动脉瓣狭窄、主动脉瓣反流和二尖瓣反流。目前,经导管主动脉瓣置换术(TAVR)治疗主动脉瓣狭窄的适应证已经扩展到外科手术低危患者。新的瓣膜设计在可回收、减少瓣周漏、提高瓣膜耐用性等方面进行创新。TAVR治疗主动脉瓣反流,第二代瓣膜预后显著优于第一代瓣膜。目前较为成熟的方案主要经心尖入路置入,通过特殊装置锚定于自身瓣膜结构,经股动脉入路是未来的发展方向。随着冠状动脉血运重建率提高和风湿热发病率下降,退行性二尖瓣反流逐渐成为原发性二尖瓣反流的主体。目前介入治疗退行性二尖瓣反流术式主要包括经导管缘对缘修复、经心尖人工腱索置入等;另外对于退行性二尖瓣反流合并中重度三尖瓣反流的患者,一站式联合治疗可以优化心肌重构,改善心功能,但远期预后尚需更多研究进一步证实;对于接受TAVR同时合并严重三尖瓣反流的患者,一站式处理三尖瓣反流和主动脉瓣疾病或可改善预后。

关键词(KeyWords)： 心脏瓣膜病;介入治疗;主动脉瓣狭窄;经导管主动脉瓣置换术

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 朱风琴,龙愉良,潘文志

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