Download Stenosis of the mitral valve

Gained vices
of the heart
and
coronary artery
disease
Prevalence and etiology.
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Most of acquired heart failures have rheumatic etiology.
It’s marked that changes of mitral valve are occurred in
90% , aortal – 50%, tricuspid -20%
Rheumatic heart disease is common between young
people(until 40). It develops by type of endomyocarditis.
Endocarditis leads to loss of valve substance with
developing of defects, perforations.
More seldom they can be occurred at coronary artery
disease, diseases of connective tissue (Marfan’s
syndrome), atherosclerosis, closed trauma of heart,
bacterial endocarditis or congenital abnormalities.
Mitral insufficiency
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Isolated mitral insufficiency is less common (about 2%),
usually it’s connected with another failures.
There are 2 types: relative and organic mitral
insufficiency.
First operation of prosthetic appliance of mitral valve was
done by American surgeon Lillehay in 1958
In 1962 V.I.Shumakov offered original spherical
prosthetics , but later the operation complicated by
thrombosis.
Nowadays there are used 1-and 2 – petalous,
hemispherical and other types of artificial valves, and
also bioprosthetics – swine heterovalves.
Mitral stenosis
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30% of all mitral valve failures. According to
V.H.Vasilenko it exsists at 500-800 patients on 100000
of population.
 30-60% of patients in anamnesis had no obvious attacks
and rheumatic disease is without symptoms. This failure
is formed in young age at women.
 There are mild (d – till 0,5 sm), middle ( 0,5-1 sm) and
severe ( more than 1 sm). Normally the area of
atrioventicle foramen is 4.5 -11 sm 2
 primary the operation of stenosis liquidation was done
by English surgeon Suttar in 1925 by finger mitral
comissurotomy. During the impossibility of finger
dilatation there is used Dubost dilatator.
Aortic valve insufficiency
 Isolated
type at 20-30 % of cases, at male
10 times more often than at female.
 Among people died from heart failures it is
occurred at 14%
 Aortic insufficiency stimulate retrograde floe
5-50% of systolic blood from aorta to left
ventricle, which causes compensatory
dilatation of left ventricle and its hyper trophy
Aortal stenosis
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Occurred at 20-23% of people died from heart failures.
It’s more common for people in young and middle age
and occurred at male more often. (2,4:1).
Narrowing of aortic valve put obstacles in the way to left
ventricle , which causes prolonging of systolic phase of
left ventricle, increasing of pressure in it. Gradient of
pressure in the system “aorta-left ventricle” is 50-150
мм hg., it causes fast developing of hypertrophy of
left ventricle, usually without widening of its cavity.
Аортал стеноз
Coronary artery disease
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According to WHO , CAD exists 53 % of all death cases
from cardiovascular diseases between 45-64 years.
In the USA annually is occurred 600 000 deaths from
this disease, and economic loss is accounted many
billion dollars in a year.
In developed countries about 20% of healthy working
men at the age of 60 are at risk of CAD.
In Russia it takes a leading place between
cardiovascular disease, accounting 28%. In 2005 in
Russian Federation there are died 550000 of people
because of myocardial infarction.
In Uzbekistan
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In 1960 was performed finger and later instrumental
comissurotomy
At this year was performed first pericardiotomy at
pericarditis, in 1969 implantation of cardiostimulator
during atrioventicle blockage.
In our country first operation of aortocoronary shunting
was performed at the Republic Centre of Surgery in
1988, founded by acad. V.V. Vakhidov with Russian
colleagues prof. B.V. Shabalkin and YU.V.Belov.
In Uzbekistan
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From our surgeons first in republic it was performed by
B.L.Gambarin in 1988-89, then E.A.Karimov in 1989 – 1993.
Between 1992and 1995 it was performed by A.V. Vakhidov.
A great role in Uzbekistan played Yu.P.Andres, D.F. Yugay and
N.U.Sharapov. N.U.Sharapov also made a great work at introducing
of resection and plastic of postinfarctional aneurisms of left venticle
– one of the heaviest comlications of myocardial infarction.
F.Sh. Bakhritdinov began to perform coronary operations between
1996-2005 years and had dome about 100 operations of myocardial
revascularisation. Before this time there was used autovenous
transplantants, but F.Sh. Bakhritdinov used autoarterial conduits –
brachial artery. There were made combined operations on coronary
arteries and branches of aortic arch, resection and plastic of left
ventricle aneurisms.
Mitral stenosis
Comissurotomy with finger
Stage of the close mitral comissurotomy
Stenosis of the mitral valve
Instrumental mitral comissurotomy
Artificial valves of the heart
Mitral vise of the heart
Mitral stenosis.
Stage of the section of the mitral valve
Macropreparate of the mitral valve.
Combined mitral vice with the prevalence
of the insufficiency
Stage of the prosthesis of the cardiac valve
Artificial valve of the heart
X-ray of the chest
Stage of the prosthesis of the cardiac valve
ANATOMY OF THE CORONAR ARTERIES
OF THE HEART
Stenting
Stenting
X-ray endovascular interventions are performing at the Xray operation room, equipped with the digital
angiocardiographic installation
For performance of the interventions at the coronar
arteries are frequently used the access from the femoral
artery
Less frequently is
used the access from
the vessels of the
upper extremities
(axillar and radial)
Allen’s test
Точка
пункции
Точка
пункции
STAGES OF THE BALLOON ANGIOPLASTIC
A) Passing of the intraducer through the defeated part of the CA
B) extending of the balloon with the compression of the atherosclerotic athery
c) Installation of the balloon at the level of defeat; D) reconstruction of the passability of
the CA;
Stages of the stenting
А
INSTALLATION OF THE
SYSTEM
STENT-BALLOON
IN THE ZONE OF DEFEAT
В
EXTENDING OF THE SYSTEM
BALLOON-STENT
AT THE LEVEL OF DEFEAT
С
AFTER THE IMPLANTATION
OF THE STENT
(FRAMEWORK FUNCTION THE SPOT IS RECONSTRUCTED)
Operations on the heart at the CAD
Aortocoronar shunting
Mammarocoronar shunting
Operations on the heart at the CAD
Aortocoronar shunting
Mammarocoronar shunting