杂交技术在肌部室间隔缺损治疗中的应.pptVIP

Technique—pathwayestablishmentapurse-stringsutureatthelocation,puncturewitha20gaugeneedle,guidewirewasintroducedintotheLVthroughthedefectunderTEE01AdeliversheathwasadvancedoverthewireintotheLV,thenthedevicewasdeliveredthroughthesheath.02Technique--occluderMuscularoccluderPDAoccluder(forapicaldefect)0102Follow-upTTEandECGatdischargeand6monthsafterdischarge;Anyresidualshunt,arrhythmiaornewvalveproblemwouldberecorded.12两枚PDA封堵器病例4：MVSD×4+ASD2139月，6kg，重度PH4个MVSD、合并ASD使用3枚MVSD封堵器、1枚ASD封堵器，全部封堵成功44个MVSD中，有3个缺损彼此相邻病例4：MVSD×4+ASD需要预先建立两个轨道01第一个鞘管进入并封堵室缺02第二个鞘管进入并封堵室缺03封堵第三个室缺04图中见2枚MVSD伞和ASD伞图中见3个肌部伞手术后X光片见3枚肌部VSD伞和ASD伞讨论对外周血管潜在的损伤受病人年龄和体重的限制室缺靠室隔前份或心尖时，经皮封堵失败的可能性大存在射线照射对婴幼儿的影响经皮介入封堵存在的不足讨论封堵器收放容易便于选伞操作灵活、准确放伞实时评估疗效，减少残余漏；合理选伞心室穿刺封堵术的优势有:讨论合并其他畸形时，如封堵成功，可明显缩短体外循环时间；单纯MVSD可避免体外循环避免心室切开，保护右室功能，减少心律失常的发生讨论TEE在穿刺点选择中的引导作用；术前超声检查；TEE在轨道建立过程中的引导作用；超声在评估中的作用超声心动图的重要性超声医生-外科医生的配合保证手术的成功超声医生对外科的理解外科医生对图像的理解两者的结合：经超声医生的手得到图像经外科医生的手实施操作。010302结论经心室穿刺封堵MVSD是一种安全、有效和微创的治疗手段，其短期效果满意01经心室穿刺与经皮介入封堵肌部室缺相比，基本不受患儿年龄及缺损位置限制，且选伞灵活02其远期效果，如心律失常、心室功能的远期影响尚有待进一步观察0301英文版TheapplicationofhybridtechniqueformuscularventricularseptaldefectsYing-kangShi,QiAnDepartmentofThoracicandCardiovascularSurgeryWestChinaHospital,SichuanUniversity12SurgicalrepairofMVSD:poorexposure,chanceofventriculotomy,andhighincidenceofresidualshunt;Transcatheterclosure:limitedbyvesselconditioninyoungchildrenneedingearlyintervention;Transcatheterclosure:minimallyinvasive,buthardtoestablishthepathwayandthesuccessrateislower.BackgroundPerventriculardeviceclosure(PDC)maybethethirdchoiceandprobablyprovidespartofthepatientsachancetogetminimallyinvasivetreatmentcomparedtoon-pumpsurgeryPatientsMethodsMay2007toJuly2009,thirteenpatientswithsingleormultipleMVSDs,includingatraumaticone