《国际循环》：作为知名结构性心脏病专家，能否简要回顾一下近20年来在结构性心脏病的诊治方面取得的重大进展？

戴汝平教授：中华医学会心血管病学分会明确提出要建立结构性心脏病专门学组，此举意义重大。该学组的成立还原了心血管病的原貌，即心血管病包括了累及心血管系统的所有疾病。近年随着社会的发展，疾病谱逐渐改变，冠心病被喻为人类第一杀手，受到广泛关注。与此同时，其他心血管疾病相对被忽视。如果这种观念的转变为医生带来错误的引导，导致所有医生跟风研究冠心病，整个心脏科成了冠心病科，甚至冠心病科又变成了导管治疗科，对于医院建设和学科整体结构而言十分不利，最终必将损害患者的利益。

风湿性心脏病
虽然结构性心脏病相对处于被遗忘的角落，但是仍有广大医生在努力进取，20年来取得了很多成果。最初对瓣膜病治疗的突破主要集中于风心病二尖瓣狭窄，从1985年陈传荣等教授带领的研究队伍，引用日本的技术方法扩张肺动脉狭窄，逐渐向全国推广。当时风心病发病率很高，在心血管病中约占40%~45%，是侵犯劳动人民最严重的心脏病。该技术在全国的迅速发展，共治疗约5~7万的病例。而当时学习二尖瓣狭窄球囊扩张的医生，现在很多都在冠心病方面具有杰出贡献。目前一些省份仍是风心病高发区，如四川、广西、湖南、江西等，全国每年约进行2000例手术。近年国产球囊的推出对风心病患者来说意义重大。15年远期随访结果（100~200例）显示，正常改善率在15年内会达到79%。

目前很多医生更多地考虑采用瓣膜置换手术治疗患者，但其后必须进行抗凝治疗，如果治疗不当，易发生出血事件。而如果保留自体瓣，进行球囊扩张，可减少患者风湿热的发生，有的患者无症状的生存率可以达到95%。因此，从远期效果来看，我们再次提出对于青中年人，单纯的二尖瓣狭窄应首先做球囊扩张。

先天性心脏病
先天性心脏病的介入治疗也始于80年代初，当时技术还不是很完善。其技术和瓣膜病的技术是相通的。目前我国有几百万的先心病患者，每年新增十几万，但每年手术量只在5万例左右。从开始每年仅几百人进行介入治疗，发展到现在每年可以完成2万例。主要原因有两方面：一是医生的基础交流，二是技术的发展，特别是封堵伞技术的推广。目前国产封堵伞质量过关，价格相对便宜，受益患者更多，2003~2004年就突破了1万例，2005~2006年已达1.8万例，2007年突破了2万例。

心肌病
结构性心脏病包括3大方面：瓣膜病、先心病和心肌病。心肌病的介入治疗主要指的是肥厚性心肌病的治疗。肥厚性心肌病一般进行化学消融治疗，通过冠状动脉消融肥厚心肌，造成人为心肌梗死，使肥厚的心肌萎缩变薄，减少梗阻的发生，以防止患者发生猝死。肥厚性心肌病发病率是0.3%，但其猝死的发生率很高。此外晚期消融也是很新的技术，我们开展了近十年的研究，总例数约1000例左右，但此技术仍需进一步研究和推广。希望有志的年轻医生积极投身器材的开发和方法的改进，如化学消融注入的无水酒精剂量等难题。其远期疗效尚无随访研究结果，而2~3年总的随访结果较好，但是也有复发病例，10%患者最后会出现高度的房室传导阻滞。10%术后安放起搏器，有严重并发症需要解决，原因在于其技术仍需改进，此外可控性尚待解决。

Prof. Gia Khai Pham: Medical imaging diagnosis has made great progress nowadays in structural heart disease， as well as in other heart diseases. Through medical imaging， we can make proper diagnosis accurately. Hence， we can cure the patients for many cases. Recently ultrasound in cardiology， besides CT and MRI， in a brief， has been quite important as far as the current progress of technology is concerned.

<International Circulation>: While structural heart disease， a branch of cardiology， has made rapid progress. New equipments and new methods emerged. Could you talk about the future? What shall we do when we are facing the challenge? 

Prof. Gia Khai Pham:  In my opinion the future is bright. I say so not because I am the first person who has introduced interventional cardiology to Vietnam in 1997， but because interventional cardiology does have bright future not only in Vietnam but also in China， as well as in other countries， even in America. It benefits from many progresses in numerous fields. We have inter-disciplinary methods that can be merged into curing the diseases. For instance， we have medical imaging methods， interventional cardiology， video assisted robots， and stem cells， all of which will have a bright future. So does the treatment of heart failure. There has been great progress， not only in drugs， but also in mechanical procedures.
The first thing of consideration is to face the challenge. Challenge is some kind of gift that God offered us， because it is the struggle between evil and angel， what we must always face to no challenge， no life. So as a physician， I would like to take challenge. People are thinking and making exertion consistently. In addition， there is no barrier between generations， while new generation succeeded the elder one， constructing alliance of struggle against the diseases.

《国际循环》：在结构性心脏病的治疗上，如何正确处理内外科的关系？

戴汝平教授：介入治疗本身是一个跨学科的技术，是综合了影像、外科技术、内科治疗学的边缘学科，其归属问题并不是十分重要，正如邓小平同志所讲的“不要考虑是姓资还是姓社”，“不管黑猫白猫，抓住老鼠即是好猫”。再过几年根据其发展情况，大家可能对其位置会有一个较明确的认识和定义。目前为止，对医生来说，要掌握这门技术，就要集综合知识于一身：影像学基础、外科医生的手的灵活度和内科医生慎密的思维。

Prof. Gia Khai Pham: With the advancing in interventional cardiology， many cases of acquired heart disease as well as congenital heart disease had been diagnosed successfully. In the developing countries， such as Vietnam and southern China， rheumatic heart diseases are still problems in the rural areas. But we can handle many cases with interventional methods， such as ballooning and PBMC. Ten years ago in Vietnam， there were lots of patients with mitral valve disease， like mitral valve stenosis， but nowadays there is fewer， partly because of better prevention and proper treatments. As for how to balance them， in the past， most of the cases had to be operated on， but nowadays， it is not only surgery being used， but also interventional cardiology and drug therapy. For instance， even for the most advanced technology， statins or stem cells， we can improve the effect of treatment for those patients. Hence drug therapy is as important as surgery， so it is called interventional-drug therapy.