【文档说明】先天性心脏病封堵治疗基础超声影像课件.ppt，共(50)页，1.035 MB，由小橙橙上传

转载请保留链接：https://www.ichengzhen.cn/view-254486.html

以下为本文档部分文字说明：

先天性心脏病封堵治疗基础超声影像福建医科大学附属协和医院心内科福建省冠心病研究所陈良龙MDPhDFACCFightingCVD2023/5/231LLCHENMDPhDFACC1.导管房间隔缺损封堵术2023

/5/234LLCHENMDPhDFACC术前ASD超声评估⚫ASD位置/形态/数目⚫选择合适ADO2023/5/235LLCHENMDPhDFACC心尖四腔观房间隔全长◼最大ADO缺损直径◼解剖◼扩张缺损边缘◼有无◼厚薄周围结构◼PV◼CS◼S

VC\IVC◼MV\TVAB2023/5/236LLCHENMDPhDFACC剑下四腔观AB房间隔全长◼最大ADO缺损直径◼解剖◼扩张缺损边缘◼有无◼厚薄周围结构◼PV◼CS◼SVC\IVC◼MV\TV2023/5/237LLCHENMDPhDFACC心底短轴观主动脉

对侧房缺边缘长度主动脉侧房缺边缘长度周围结构◼主动脉根部◼SVC◼MVAB2023/5/238LLCHENMDPhDFACC剑下下腔观AB房间隔缺损在IVC侧边缘残端◼有无◼厚薄IVC侧边缘无残端容易导致封堵失败202

3/5/239LLCHENMDPhDFACC术中封堵器能否释放⚫夹住房间隔残端的超声影像观察⚫排除封堵器占位的超声影像观察2023/5/2310LLCHENMDPhDFACC心尖四腔观:通过牵/拉输送系统

确定房间隔前下/后上是否被封堵器夹住确定封堵器是否正常、移位。AB2023/5/2311LLCHENMDPhDFACC剑下四腔观:通过牵/拉输送系统AB确定房间隔前下/后上是否被封堵器夹住确定封堵器是否移位2023/5

/2312LLCHENMDPhDFACC心底短轴观:通过牵/拉输送系统AB确定封堵器是否夹住主动脉侧房缺残端或抱住主A根部确定封堵器是否夹住主动脉对侧房缺残端2023/5/2313LLCHENMD

PhDFACC各切面观:排除封堵器占位二三尖瓣肺静脉冠状窦上下腔静脉AB2023/5/2314LLCHENMDPhDFACC封堵效果好的超声影像观察术后ASD封堵效果观察2023/5/2315LLCHENMDPhDFACC心尖四腔及大动

脉短轴观补片位置和形态良好对二、三尖瓣无影响对肺静脉回流无影响良好环抱主动脉AB2023/5/2316LLCHENMDPhDFACC2.经导管VSD封堵术2023/5/2317LLCHENMDPhDFACC术前VSD超声评估⚫VSD位置/形态/数目⚫选择合适ADO2023/5/2318

LLCHENMDPhDFACC室间隔缺损的形态分类管状窗状囊袋型漏斗型2023/5/2319LLCHENMDPhDFACC心尖五(四)腔心切面室间隔缺损边缘距主动脉瓣距离◼与瓣环的距离◼与窦的距离◼窦脱垂室间隔缺损的形态◼长管状◼短窗型◼漏斗状◼囊袋状：多漏口，基底宽

室间隔缺损与三尖瓣的关系◼囊袋状缺损与三尖瓣粘连◼三尖瓣粘连封闭缺损2023/5/2320LLCHENMDPhDFACC左心室长轴切面室间隔缺损边缘距主动脉瓣距离◼与瓣环的距离◼与窦的距离◼窦脱垂室间隔缺损与三尖瓣的关系◼三尖瓣粘连封闭缺

损◼囊袋状缺损与三尖瓣粘连2023/5/2321LLCHENMDPhDFACC心底短轴切面室间隔缺损的位置◼脊下型，膜部，膜周部◼脊内型，脊上型，干下型室间隔缺损的大小右室流出道情况2023/5/2322LLCHENMDPhDFA

CC术中VSD封堵超声监测⚫封堵过程是否影响重要结构⚫封堵效果及残余分流2023/5/2323LLCHENMDPhDFACC心尖五（四）腔心切面观察输送导管穿过室间隔观察出鞘的封堵器是否影响二尖瓣腱索引起关闭不全2023/5/2324LLCHENMDPhDFACC

心尖五（四）腔心切面观察封堵器位置是否正常观察封堵器是否完全封堵缺损，是否有残余分流2023/5/2325LLCHENMDPhDFACC心尖五（四）腔心切面观察封堵器是否引起主动脉瓣关闭不全◼是否触及主动脉窦◼是否影响主动脉瓣关闭

观察封堵器是否引起三尖瓣关闭不全◼三尖瓣腱索被夹，断裂◼低血压2023/5/2326LLCHENMDPhDFACC左室长轴切面观察封堵器是否引起主动脉瓣关闭不全，是否触及主动脉窦或引起主动脉窦变形2023/5/2327LLCHENMDPhDFACC⚫封堵效果

与并发症术后VSD封堵效果观察2023/5/2328LLCHENMDPhDFACC成功封堵封堵器位置良好无主动脉瓣返流无三尖瓣返流无主动脉窦变形可释放封堵器2023/5/2329LLCHEN

MDPhDFACC3.超声引导PDA封堵术2023/5/2330LLCHENMDPhDFACC测量PDA大小、观察其形态、选择封堵器Figure1.Theampullaandtheductconnectionbet

weenthedescendingaortaandtheleftpulmonaryarteryinapatientwithamegaphone-likePDAwereclearlyvisualizedontheparasternalshortaxi

sview,andMDDof4.3mmand4.5mmwasaccuratelymeasuredin2DEimage(1A)andCDFImapping(1B),respectively.Theinterrogatedepthwas15cmunlessotherwiseindicat

ed.2023/5/2331LLCHENMDPhDFACC准确测量PDA大小Figure2.2DEdidnotcompletelyrevealtheductmorphologyinapatientw

ithasmallPDA(2A);whileCDFIclearlydetectedaductshuntingjetenteringthepulmonaryarteryfromthedescendingaorta,producingavena-contract

aphenomenon(2B),andthejetwidthof2.3mmwasmeasuredatthepoint(arrow)ofthevena-contractainthiscase,whichwasanalternativetodirect2DEmeasurement2

023/5/2332LLCHENMDPhDFACC准确测量PDA大小及合适选择封堵器ThemeasurementsofSDDandMDDin60patientswithafirstorasecondsuccessfulocclusionwere7.1±2.7mm(3.5-17.2mm

)and5.4±1.4mm(3.1-10.3mm),respectively(P0.001).Andtherewashighlylinearrelationship(SDD=1.67MDD-2.0

2,r=0.95,SEE=0.58,P0.01)betweenSDDandMDDy=1.6693x-2.0153R2=0.8931024681012141618200.02.04.06.08.010.012.0MDD(mm)SDD(mm)2023/5/2333LLCHENMDPhDFA

CC封堵器定位、形态判断、占位效应Figure3.Duringtheprocedure,whentheretentiondiskwasdeployed,2DEcouldclearlyrevealedtheextendeddiskag

ainsttheductampulla(3A);andfurtherwithdrawthedeliverysheathwasindicatedtodeploytheconicalsegmentofthedevice(3B);aproperlyp

ositioningoccluderusuallyshowedanI-shapedappearancewiththeretentiondiskcloselyagainsttheampulla(3C);therewerenotan

yADOprotrusionintotheleftpulmonaryartery(3D)2023/5/2334LLCHENMDPhDFACC封堵器定位、形态判断、占位效应Figure4Onamodifiedsuper-sternallongaxisviewoftheaortaarchwiththe

probetiltedleftward,awell-positioningADO(arrow)wasclearlyseenwithmildoccupationoftheleftpulmonaryarteryin2DEimage(4A),andCDFIdemonstra

tedlocalflowturbulence(4B),indicatingADO-producedmildstenosisoftheleftpulmonaryartery.Onasuper-sternallongaxisviewoftheaortaarch,anADO(a

rrow)wasclearlyseenwithmoderateoccupationofthedescendingaortain2DEimage(4C),andCDFIdemonstratedlocalflowturbulence(4D),indicatin

gADO-producedmoderatestenosisofthedescendingaorta.Theinterrogatedepthwas9cminfigure4C,4D.2023/5/2335LLCHENMDP

hDFACC残余分流观察、更换封堵器Figure5.Ontheleftpanel,CDFIdetectedasmallmarginalresidualshuntwithawidthof0.9mmimmediatelyafterwell-positionofanADO(5A),andCDFIc

ontinuousmonitoringrevealedtheshuntbecomesmallerat10min(5C)andfinallyvanishedat20min(5E).Conversely,ont

herightpanel,CDFIdetectedalargemarginalresidualshuntwithawidthof2.1mmimmediatelyafterwell-positionofanADO(5B),andCDFIcontinuousmonitoringrevealedthe

shuntdidnotchangeat10min(5D)andat30min(5F).2023/5/2336LLCHENMDPhDFACC2023/5/2337LLCHENMDPhDFACC2023/5/2338LLCHENMDPhDFACC2

023/5/2339LLCHENMDPhDFACC2023/5/2340LLCHENMDPhDFACCS2及早发现及有效规避并发症2023/5/2341LLCHENMDPhDFACCASD封堵术并发症病

例—右心气栓2023/5/2342LLCHENMDPhDFACCDualASDoccluders2023/5/2343LLCHENMDPhDFACCVSD封堵术并发症病例—三尖瓣腱索断裂2023/5/2345LLCHENMDPhDFACC准确的封堵器定位、形态判断、占位效应Figu

re4Onamodifiedsuper-sternallongaxisviewoftheaortaarchwiththeprobetiltedleftward,awell-positioningADO(arrow)wasclearlyseenwithmildoccupationofthel

eftpulmonaryarteryin2DEimage(4A),andCDFIdemonstratedlocalflowturbulence(4B),indicatingADO-producedmildstenosisoftheleftpulmonar

yartery.Onasuper-sternallongaxisviewoftheaortaarch,anADO(arrow)wasclearlyseenwithmoderateoccupationofthedescendingaortain2DEimage(4C),andCDFI

demonstratedlocalflowturbulence(4D),indicatingADO-producedmoderatestenosisofthedescendingaorta.Theinterrogatedepthwas9cminfi

gure4C,4D.2023/5/2346LLCHENMDPhDFACCS3全数字便携彩色多普勒超声诊断仪Terasont30002023/5/2349LLCHENMDPhDFACC2023/5/2350LLCHENMDPhDFACC

2023/5/2351LLCHENMDPhDFACC2023/5/2352LLCHENMDPhDFACCTerasont3000Terasont3000加强型15.1吋高亮度、高分辨率、真彩显示屏15.4吋高亮度、高

分辨率、真彩显示屏Centrino（迅驰）配置、WindowsXP平台Duel-CoreCentrino（迅驰）配置、WindowsXP平台**全息数码成像技术软件全息数码成像技术软件专利技术数码多声束形成技术专利技术数码多声束形成技术高倍数字处理通道软件双倍高倍数字处理通道软件**全程

动态均匀聚焦全程动态均匀聚焦组织特性成像软件组织特性成像软件超宽频扫描软件超宽频扫描软件实时三同步功能软件实时三同步功能软件B型、D型、M型及扫描软件B型、D型、M型及扫描软件全息解剖M型（取样线可作360度旋转取样）全息解剖M型（取样

线可作360度旋转取样）彩色能量多普勒、彩色方向性能量多普勒软件彩色能量多普勒、彩色方向性能量多普勒软件PW/CW多普勒血流测量与分析PW/CW多普勒血流测量与分析组织多普勒（TDI）组织多普勒（TDI）组织谐波成像技术组织谐

波成像技术无OMNI成像软件**,完整的StressEcho(选配)**更高帧频**2023/5/2353LLCHENMDPhDFACCTerasont3000Terasont3000加强型原始数据处理软件；原始数据图像动、静态电影存储/回放软件原始数据

处理软件；原始数据图像动、静态电影存储/回放软件伪彩软件(BColorPalette)伪彩软件(BColorPalette)各专科测量、计算、分析软件各专科测量、计算、分析软件原始数据动、静态图像存储/回放及处理

、编辑功能原始数据动、静态图像存储/回放及处理、编辑功能网卡/有线—无线网络服务功能，支持无线升级网卡/有线—无线网络服务功能，支持无线升级Dicom、、Tif、Avi、Jpg、Bmp等图文格式存储Dicom、、T

if、Avi、Jpg、Bmp等图文格式存储USB、大/小1394、视频、通用打印机、宽带、电话网、红外线等传输接口USB、大/小1394、视频、通用打印机、宽带、电话网、红外线等传输接口可读写DVD光盘刻

录机可读写DVD光盘刻录机专业超声操作键盘专业超声操作键盘锂电池一块锂电池一块电子操作手册电子操作手册超宽频变频电子线阵探头系列12L5-LinearArray线阵探头，应用：小器官、外周血管超宽频变频电子线阵探头系列12L5-LinearArray线

阵探头，应用：小器官、外周血管超宽频变频电子相控阵探头4V2-PhasedArray相控阵探头，应用：心脏、腹部超宽频变频电子相控阵探头4V2-PhasedArray相控阵探头，应用：心脏、腹部超宽频变频

C形凸阵探头:5C2A超宽频变频C形凸阵探头:5C2A可接驳更多特殊探头（如食道探头等）**2023/5/2354LLCHENMDPhDFACC感谢！FightingCVD2023/5/2355LLCHENMDPhDFACC