经皮冠状动脉干预的相对禁忌症：严重左室功能衰竭PPT.pptVIP

Percutaneous Coronary Interventions for Patients with Relative Contra-indications: Severely Depressed Left Ventricular Function  Great Wall International Conference on Cardiology. Beijing 11.5.2005 Thach Nguyen MD FACC FACP FSCAI What is the most Common Cause of Death among Patients Undergoing PCI? In Which Scenario I Will Do PCI Even The EF Is Low (25%) ? 3 Scenario 1: AMI (EF25%) Patient A: ST Segment Elevation. Heart Rate=70 and Blood Pressure 130/80 Patient B: ST Segment Elevation in Inferior leads, 2,3,F and V2R, V3R = RV MI HR:120 BP: 80/60. Mortality = ? Patient C: ST Segment Elevation in Anterior leads V1-V6. HR:120 BP: 80/50 How much is the mortality after PCI? What Do I Look When I Come To Evaluate a Patient with Very Low Ejection Fraction (25%) For PCI ? Evaluation of Patient with Very Low Ejection Fraction (25%) before PCI 1. Does the Patient Have Frank Heart Failure ? 2. Does the Patient Have Moderate Mitral Regurgitation ? 3. Does the Patient Have Moderate Tricuspid Regurgitation ? 4. Is the Diagonal closed and/or a large Posterior Descending Artery from a dominant RCA or dominant Obtuse Marginal closed ? Moderate Risk Patient (Ejection Fraction 25%) 1. Frank Heart Failure No 2. Mitral Regurgitation Mild 3. Diagonal or Posterior Descending Artery or Obtuse Marginal OPEN Why I am Interested in Patency of PDA and Diagonal Branch? Right dominant RCA PDA Left dominant PDA LAD LCx LAO views Scenario 3: Stable Angina (EF25%) Patient has low EF and no other non-invasive data Pre-Operative Evaluation? 1. Does the Patient Have Moderate Mitral Regurgitation ? 2. Does the Patient Have Moderate Tricuspid Regurgitation ? 3. Is the Diagonal closed and/or a large Posterior Descending Artery from a dominant RCA or dominant Obtuse Marginal closed ? Moderate Risk Patient (Ejection Fraction 25%) 1. Frank Heart Failure No 2. Mitral Regurgitation Mild to moderate 3. Tricuspi