Vahanian Alec, Ducrocq Gregory
Service de cardiologie, Hôpital Bichat, Paris, France.
Curr Opin Crit Care. 2008 Oct;14(5):555-60. doi: 10.1097/MCC.0b013e32830d34d5.
This review will deal with strategies for emergency management of patients with valve disease, a situation that is now rare but remains a very challenging problem: valvular patients are often elderly with a high frequency of comorbidity; furthermore, there is a growing proportion of previously operated patients who present with further problems.
The main treatment is valve replacement, however, the conservative surgical approach is developing, and, more recently, percutaneous interventional techniques have been introduced. Percutaneous mitral commissurotomy is an established treatment for mitral stenosis whereas transcatheter aortic valve implantation, which is presently at the evaluation phase, shows promise.
The keys to success are establishing a rapid diagnosis based mainly on echocardiography followed by early intervention. Every effort should be made to avoid performing intervention in an emergency setting, as it is always of high risk. Strategies include better patient and physician education in order to decrease the incidence of endocarditis and prosthetic-related complications such as thromboembolism and considering earlier intervention when symptoms or objective signs of ventricular dysfunction are observed in patients with known valve disease.
本综述将探讨瓣膜病患者的急诊处理策略，这种情况如今虽不常见，但仍是一个极具挑战性的问题：瓣膜病患者往往年事已高，合并症发生率高；此外，曾接受手术的患者出现进一步问题的比例也在不断增加。
主要治疗方法是瓣膜置换，但保守手术方法也在发展，最近还引入了经皮介入技术。经皮球囊二尖瓣成形术是二尖瓣狭窄的既定治疗方法，而目前处于评估阶段的经导管主动脉瓣植入术显示出前景。
成功的关键在于主要基于超声心动图进行快速诊断，然后尽早干预。应尽一切努力避免在紧急情况下进行干预，因为紧急干预风险始终很高。策略包括加强患者和医生教育，以降低心内膜炎及血栓栓塞等人工瓣膜相关并发症的发生率，并在已知瓣膜病患者出现心室功能障碍的症状或客观体征时考虑更早进行干预。
