(精选)【医学课件课件】冠心病教学课件.pptVIP

Management of the complications Significant PR and RV dilatation Pulmonic valve replacement with homograft or porcine bioprosthesis Timing of surgery is debated. Selection of asymptomatic patient ?criteria. Might TV annuloplasty if concomitant moderate to severe TR. Restrictive RV Diuretics in the post-operative period. Residual RVOTO Indicated if RVSP2/3 systemic pressure. Surgery or balloon angioplasty with stenting. Management of complications Aneurysmal dilatation of the RVOT Residual VSD: Surgical correction if Qp/Qs2:1 or 1.5-2:1 with LV dilatation or dysfunctionor H/O paradoxical emboli Dilatation of aortic root: Aortic root replacement when ascending aorta55 mm and/or in the presence severe AI. Management of the Complications Heart block: Patients with bifascicular block with prolonged PR (0.20 msec) should have holter or EPS. If true trifascicular block is documented then pacemaker. SVT Correction of target residual hemodynamic lesions. RF ablation for a.flutter or reentrant tachycardia either percutaneously or during surgery. Biatrial maze for a.fib. Anti-arrhythmic meds /antitachycardia pacemakers can be used as adjunctivetools. Management of Complications VT Correction of the hemodynamic lesions RF ablation of VT focus Role of AICD (?) Antiarrhythmic meds for symptomatic patients. SCD Resuscitated SCD-AICD Role of prophylactic AICD (?) Fontan procedure-requiring patient Tricuspid atresia Hypoplastic left ventricle Double inlet ventricle Isomerism Tricuspid atresia Tricuspid Atresia On Echo Hypoplastic Left Heart Double Inlet Ventricle Fontan procedure 10 year survival is 60-70% Poor prognosis 5 year survival 46-59% Fontan Patient Long term complications include Atrial flutter or fibrillation Incidence increases with time Right atrial thrombus formation Obstruction of the Fontan circuit Should be r/o in all pts presenting with atrial arrhythmias Ventricular dysfunction Protein losing enteropathy Etiology unclear: pleural effu