老年退行性瓣膜病的临床特点及对策

Clinical characters and managements of senile degenerative valvular heart disease

关键词:  老年退行性瓣膜病  心脏瓣膜置换术  经皮瓣膜成形术  经皮瓣膜置入术

Key words:  senile degenerative valvular heart disease  cardiac valve replacement  percutaneous valvuloplasty  percutaneous valve replacement

摘要:

随着生活质量的提高和生活方式的改变，老年退行性瓣膜病发病率逐年增高，其发病机制尚不十分清楚。病变主要累及左心瓣膜，引起钙化性主动脉瓣狭窄最为常见，二尖瓣脱垂致关闭不全次之。其病情发展缓慢，一旦出现症状生存期则明显缩短。药物治疗对轻者可以改善症状，重危患者往往难以奏效。对于主动脉瓣狭窄和二尖瓣关闭不全而言，人工瓣膜置换术仍然是目前公认有效的治疗方法，选择和把握手术时机十分重要。经皮球囊主动脉瓣成形术作为一种姑息性治疗手段可以改善高龄高危患者的临床症状。经皮导管主动脉瓣置入术及经皮二尖瓣成形技术将成为近几年临床上治疗老年退行性瓣膜病的研究方向，并被越来越多地应用于临床。

Abstract:

With the improvement of living and changes in life style, the prevalence of senile degenerative valvular disease increases annually.Its mechanism is unclear yet.The most frequently affected valves are the aortic and mitral valve.Calcific aortic stenosis and mitral regurgitation due to mitral valve prolapse are the most frequent valvular lesions seen in the elderly and progresses slowly.Survival significantly shortens when symptoms present.Drugs can relieve symptoms in mild lesion, while do little in patients with severe lesions.Artificial valve replacement is still the most effective therapy.Case selection and timing is crucially important.As a palliative way, transcatheter aortic valve implant may improve symptoms of aged patients with high risk.Together with the percutaneous balloon mitral valvuloplasty, it will be the focus of research in the coming decades and will develop rapidly in senile degenerative valvular diseases.