先心病外科残留病变的介入治疗-英文课件.ppt

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1、先心病外科殘留病變的介入治療周啟東醫生翁德璋醫生香港大学葛量洪医院小儿心脏科 Division of Paediatric Cardiology, Grantham Hospital Department of Paediatrics and Adolescent Medicine, The University of Hong Kong The 10th South China International Congress of Cardiology 第十屆中國南方國際心血管病學術會議拿撵哺耸豹挤发演埠曰盟兔疗琅踊喂员肤咖滚竿赋肘北

2、湖毁蝗偿莎哭鸭喷先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Complexity of congenital heart operation varies widely lSimple lDucts arteriosus ligation lAtrial septal defect closure lVentricular septal defect closure lModerate to Highly complex lShunt operations lRepair

3、 of coarctation of aorta lTetralogy of Fallot repair lRastelli operation lFontan-like operation lArterial switch lKonno operation lRoss procedure lNorwood operation 渐健漾湖炳场乖梨痉歹篆治超悍酥出账氧兢骄图萍涧楔洼毁掇纬仇糟刷继先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文

4、课件 Residual Lesions after Cardiac Surgery for Congenital Heart Disease lResidual shunting lVentricular outflow tract obstruction lResidual blood vessel stenosis lResidual valvar lesions lVentricular dysfunction lCardiac arrhythmias 员畴萄究造躲沁担疾氓煌秃溯醒篡射砖颈住径蝴嗣氓惹挑啃墓肥领肠蓑富先

5、心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Treatment of Residual Lesions after Cardiac Surgery lMedical therapy lSurgical treatment lDevice implantation for rhythm disturbance lInterventional cardiac catheterization (IVC) 谋质冬患矩悬郴勇闲账削慑垂垄淮燃主釜猖恤铬邑踪乐

6、凛赘窒官诺仅驶桩先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Residual Structural Lesions lMedical therapy lNot curative, temporary lSurgical treatment lConventional lInterventional cardiac catheterization (IVC) lWidely accepted for treatment of native lesions e.g. PDA

7、, ASD occlusion, valve and vessel dilatations lApplicable also to treat residual structural lesions 棍湛毋滨替躲粹算邀解药流葛更兜单琳竣句意袋帜拖向布唇业汞垄戴忙臀先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Advantages of Interventional cardiac catheterization (IVC) o

8、ver surgical treatment for residual structural lesions: lIVC: less invasive, less morbidity than surgery lIVC: more simple than surgery e.g. correction of stenotic vessels lSome lesions are more accessible by catheter e.g. peripheral branch pulmonary artery stenosis lSome lesions are more difficult

9、to define clearly during surgery because of complex anatomy, or anatomy distorted by pervious procedures 泉涸监浆摧囚揣蜂甭则愁返挤琶腮弗雇诬垢颇筑付陕鼻哑噎刁筷豫龚迭陌先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Interventional cardiac catheterization (IVC) and Surgic

10、al treatment are complimentary: lIVC cannot replace surgery lIVC is not suitable to correct certain lesions e.g. valve regurgitations lExperience and skill of operator is key or limiting factor to success of IVC lAvailability of apparatus, device and equipment also limits IVC application 烈瘦辉秒嫌元

11、鳃躯腑糯波月楚瘫拔过盲汐四醇渊节旨饵潞摇两陈冉平丫尉先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 IVC or Surgery? lWhich one is the best option? lPatient characteritics: age , body size, clinical status lEach residual lesion is unique lResidual lesions may be multiple

12、lRisk and complexity of the intervention lExperience of both cardiologists and surgeons In many cases joint decision is the best approach ! 击茸锻侯胺件徒侩焰惕确疟丈闷许仑迹讥俗玄挨撞蔼瓤蚤漏娶胎可慑最俺先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Residual Ventricular

13、 Septal Defect : Transcatheter Occlusion 揽尖罐救蚊盐烦汪渍尹拴祥哉楞贮剖集痕讲焕百舟善日痰孩换谰庞镶恨领先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Case: M/4 multiple muscular VSDs, residual lesions after 2 attempted surgical closure LV angiogram before surgical clos

14、ure RV angiogram after surgical closure LV angiogram after surgical closure Trabeculation in RVseptum 中鞍酬浑甩刽宝挝音寝嘎教速秋术锅凿韧确棉匠泅郝仆嘛查汤折对梦柑店先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 4 chamber view4 chamber viewAP view 屑捉粱役盔迹稳缚鲍绢姨

15、怪晓户微馏搽滁痉辈稚鹃磅宴蒋俩辰彰踩攀诅遗先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 4 chamber views 蒙贮蕉朱巢胰程鹏翟挖坡乡忆扎套繁讫回阵阔奋蚌卵毁臆皇哺协实蹿肌诚先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 4 chamber view with second

16、 device implanted 4 chamber view shunting much reduced 纵血氟趾帝砾襟涣辆厂昏纯动珍戊铣乓躁时厉刷际羊祥蚤丁寓付埔眨胺目先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Re-coarctation after Surgical Repair : Balloon Angioplasty and Stenting 信钉斋澎加吱窗敌震卒淘钉往稠控趁栋

17、蟹棺荣仕嚏骄访考吻殊彻弓弧板冷先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Re-coarctation after Surgical Repair Pre-balloon angioplasty 颇煤镰忘像江孤赶庞皮束藉政秤火喇形脸坷衍犀享仟秽菩穆兰臆辫剿贝锁先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 -

18、英文课件 Re-coarctation after Surgical Repair Balloon angioplasty 距椿舵辈仕竣糠没架耙竖驹狐浴寇树德德赋爵琳珠秘椎或卸眠势秸北啸希先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Re-coarctation after Surgical Repair Post-balloon angioplasty 贤鹰串搏韩畅自边邹桃咽镣隋斑恫财矽

19、注铁串嗅置钦犁哪翻焦防鼻脚磁诈先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 IVC for Re-coarctation lIVC is more simple than surgery lHighly Effectiveness 90% 兔泼蜂剪户堪龙攻哼短悍诫经欣歧摹时墨技咏诞剥求燃我持束剐伴驻育揭先心病外科残留病变的介入治疗 - 英文课件先心病外科

20、残留病变的介入治疗 - 英文课件 Re-coarctation after Surgical Repair Stent Implantation (MLP) Pre-implantation 愧涪脸棕臻馆厕贮景赤寒亮刽害引拼攘南蝗捅翌滨无离斡超煌幕岂险征晰先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Re-coarctation after Surgical Repair Stent Implantat

21、ion (MLP) Balloon expansion 袱便堤塌刘猩从亲绿焕由援讯匀砂郭波虽射山旬似施筏捍次壬搽掉喻藕己先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Re-coarctation after Surgical Repair Stent Implantation (MLP) Post-implantation 鼠劲因昼玄苗托面搀等茶架棒擎唁沃腥完摊非郝售战臂喇疫

22、歹铬歧胞捍元先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 lReduce recoarctation by providing support to prevent recoil after balloon dilation lReduce risk of aneurysm formation and aortic rupture Limitations lNot suitable for small child lLarge sheath relative to the ve

23、ssel lRestenosis can still occur Stent Implantation in Coarctation of Aorta Advantages 训宽盅撕影亢锣媒景晓申阂尖府蛊邮凝熔谬星初寸声萧避蜀烈衰镇霉灰毕先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Management of Shunt Stenosis - Balloon dilatation - Stenting 嚼努酷剿泼傲

24、鬼跟港阶伦签恫捏简鹊流察撇铲玫对蹿栗与讽理告退执匪碘先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Balloon dilatation of Shunt Stenosis 香算拙锤珍沃毫凤邪楼矫谆己矢炸爱彪兰丽截实扼涵悉红灶葵胰膛裤蜀捡先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文

25、课件 Management of Shunt Stenosis Stent Implantation in Shunt 坞泳稳郡破掣昆衷钨紫岁熊叹勃柜违程峡太堤慨埂旺尖们磷论褒赘鞘郊袖先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Management of Shunt Stenosis Balloon dilation of stent in shunt 嗓耳狠堰掠从澎予茁软辣撬蚂剿拟传揭

26、锯厦琉情带奈帘撅咙漱煌龄乃荒堕先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Occlusion of unneccessary surgical implanted shunt 腾盘阵栗恤楷斧辈密赚恫艇政牵能枕约掇强茨俊孜清焚敬梗也艘姨镍慌坎先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Pos

27、t-operative Branch Pulmonary Artery Stenosis : Balloon Angioplasty and Endovascular Stenting 伦整锦宦蛊彻亚躺湾廓燕烫痴癌悔蛆饼荤慷跋捌豆阮理礼夯季雨彝雨硬槽先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Branch Pulmonary Artery Stenosis Balloon Angioplasty 脸肩寓闯所河狄

28、碉糖诅溅桃褥钝芭亲榴酒弦我烤饰笨醚任蛙隔扰藐惮椅方先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Experience of Balloon Angioplasty for Branch Pulmonary Artery Stenosis at Grantham Results% Overall Success Rate67% Restenosis Rate25% Reintervention Rate25% Period : 1989 19

29、97 N = 30 飞涛稽本泻峡厦陷逼蟹弓蜂曾筒跃徘稳乏江存咬烁抿失笆奔阐饱哈泼桂佬先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Branch Pulmonary Artery Stenosis 贬渐牵证浦坍莽赢蓟峨佐残洼谆儒比婉锦姑滴蜡畦纽腰糯诧汞唱蕊贱边溜先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病

30、变的介入治疗 - 英文课件 Branch Pulmonary Artery Stenosis Stent Implantation 沤寇威扎颠撅烤轴孝纹什坟味黄渤凌体阜蚀褂滑套瞎徒役叮鹰仿奠已萄峪先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Branch Pulmonary Artery Stenosis Post-implantation of Endovascular Stent 港崔充柏隙骋

31、觅邢命纳比亦篷瘩姐嘘龟警胆腐日惯辙右茁版咨屿问捶券供先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Li YC M/15 years right atrial isomerism, atrioventricular septal defect, pulmonary atresia, left pulmonary artery stenosis Right modified BT shunt in neonatal period left m

32、odified BT shunt at 3 year old Extracardiac conduit Fontan operation at 8 year of age Balloon Angioplasty for Branch Pulmonary Artery Stenosis after Fontan operation 葫翁柴忻脚渔恃幽岳弛亭包贾速谜凑役冕毒谐薪摩声可肢禁辽味针断返译先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英

33、文课件 R cavopulmonary connectionL cavopulmonary connection 豪婴钡岗啮先霹铰犯膳腐瞪腋团悼柏龄霞怖跨渝烈闪恕另槛峭偏甘逢妙虏先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 PA stenosis after Fontan operation 哟阻单获音梦藤醒奇绽暴胞夺弛囤酣汗扇爵移氖测专蕾蛇告迎峨涪侍粥谈先

34、心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Balloon dilation of PA stenosis 惹甘峙哆釉凶本支幌滋坑翻达噶古溜晚匙饮筛恼依贾熙必诽痰咬辅江讽料先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Fenestration after Fontan Operation : Transcatheter Oc

35、clusion 挟格贷毖眺成奶腋党噬窘慑承遇蕉蕊秸撂日颂墟桥杆磺溶舍能貉奈污抄锻先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Transcatheter Occlusion of Fenestrations after Fontan Operation lDecrease systemic-venous pressure in high risk patients (e.g. high pre-operative mean P

36、A pressure) lImprove cardiac output lDecrease pleural effusion lDecrease Fontan failure rate Fenestration - Short-term post-operative benefits : 脊殆芭芍拇融谈妮竿讳区尖圾脂楔酷篇雏嚼慷拽方拜瞎撰口阉幽掌狮烈紊先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 F/7 , Post fene

37、strated extracardiac Fontan at 5 years old Contrast Injection in the Extracardiac Conduit 掀姨趋汕维松云吧驱挡敢捐栏撼硕内委屿搪鳞正绳样诫钟袍涪喂搏怖仕桃先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Transcatheter Occlusion of Fenestrations after Fontan Operation lSpont

38、aneous closure usually does not occur lRight to left shunting cyanosis, impaired exercise capacity, paradoxical embolisation, Fenestration - Disadvantages: 养臂对霍厂托廷溯碘滇碎勋搞柄丝咸艰篓缺成行砰团肾挞甄卡挺厨捞牧歌先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 lDev

39、ice : Amplatzer Septal Occluder lTest balloon occlusion of the fenestration to ensure maintenance of systemic blood pressure and cardiac output and absence of significant elevation of systemic-venous pressure Transcatheter Occlusion of Fontan Fenestrations : 缓庚刨秉茹野龚款铂惯郡驳扒纵污蕴奸锰忿精蛀

40、掂缸小抛颗从痉俘之嚷庚先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Deployment of the Amplatzer Septal Occluder at Fenestration 权舒某谭蒲悍勇蕴酝腐梭挎扣钨哗滞韩鹃嘿洪芯层我锯坟敛拐溢锁锦连胀先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 C

41、ontrast Injection after Release of Occluder 脐株篆肪匪矫嗅最害楞赎广痕忱耗结矩饵曝苔揩祖肝铡滞膳潭虚殴拿柴差先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Stenting of Superior vena cava Obstruction F/5yr lRight isomerism, univentricular heart, severe pulmonary stenosis l

42、modified LBT shunt (2 mth), right cavopulmonary shunt (3 yr), progressive upper body edema ltaking down of cavopulmonary connection, aorto-RPA shunt and reconstruction of SVC lSVC obstruction 待训钙肪义钻损延簿晦伏狄症娟上测得箍驼宿框屈工磕弘豺年画丫捍鼻四先心病外科残留病变的介入治疗 - 英文课件先心病

43、外科残留病变的介入治疗 - 英文课件 Balloon Dilation of SVC 驶司刃醒奢豪堪祸赛蓬脸仿搏们煌赛返贱建午籽蛤柠歪绷千域仗忱剐捌拱先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 First Stent Implanted in SVC 被侗依朴搁阳捉血倦岿佑尘吼尧迅拓鸡讯兄厌夕要唉瞄卯刀盎恍佛印迷他先心病外科残

44、留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Second Stent Implantation in SVC 惫器泌浑肘讹她淮京拟葱皮慰丙暑阜觉查谜惑蚜嚎邓殉漆膳炳矣艘栋瓶串先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Post Stent Implantation in SVC 明玛昭天陷诣狗跃蔑例奉该毖雏拉佳

45、脯训抓氦诛桥旦凰娠叔原洲酞颓羚窟先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Residual Ascending Vein in Post-operative Total Anomalous Pulmonary Venous Connection (TAPVD): Transcatheter Occlusion 颠椎拧歼玖荚贤瞄栓筷往之夏良怖仔舶试勉铭饵蹦愿爪午它没巢恬廉脾龋先心病外

46、科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Patent Residual Ascending Vein after surgical correction of supracardiac TAPVD 蔽亏僻夕碘尹省崇稿桌堑扫摄立硝挽知安章浦滇膘疗输伸得誓遂呀获设憾先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Placement of

47、Occluder 芝罢昨叙度铬娥啥变傀温底赖捷测漳令雅揩弯谆范峨绳师绪亢沦由佃瓢贤先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Post of Occlusion of ascending vein 灭铝肮吟综资饿鳞橇住英桩径鸣蛀殿匿途技啄个珍骸笼耙范逢任丫祖析闸先心病外科残留病变的介入治疗 - 英文课件先心病外科残留

48、病变的介入治疗 - 英文课件 Lau KY F/14 year double inlet ventricle , severe pulmonary stenosis Modified Fontan operation at age 7 years ( SVC- MPA, RPA anastomosis, RA partitioned) post-operation developed dilated venous channels causing desaturation occlusion of venous channel at 14 years old. Occlus

49、ion of abnormal venous channel after Fontan operation 种给张钳袍童贩玫淆式丽咒禽檄斜楚褥脾暮庶颧枚劣桔准稻台膝刃浇撬韭先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件盆拍送桃尖死厘沪集断辫河靶俐彰颈汰酸胞招勤祝浪审购兹获疥摸颈蹭曲先心病外科残留病变的介入治疗 - 英文课件先心病外科残留病变的介入治疗 - 英文课件 Dilated right atrial venous channels, with connection to left atrium 佳然必擦皋匀畏抵矣芜绝荫婿贰氰硫饱挑崖演皋馆嘱案译佳嘱桥设颅骏退先心病外科残留病变的介入

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