(精选)扩张型心肌病CRT治疗1例教学课件.pptVIP

* * 扩张型心肌病CRT治疗1例 典型病例 患者，男，36岁 胸闷气短1年，不能平卧伴双下肢浮肿3个月 既往：体健 查体：BP 95/60mmHg，半坐位，呼吸频率快，双下肺可闻及中小水泡音，心界扩大，HR92次/分，肝肋下4cm，双下肢可凹形浮肿 典型病例 NT-pro BNP：3620 ng/l UCG:心脏扩大，LA 4.2cm,LVEDD:6.6cm LVEF 23.75 % (Simpson法 ) ECG：窦性心律，LBBB 临床诊断： 扩张型心肌病 窦性心律 完全性左束支阻滞 心脏扩大 心功能 IV级 典型病例 术前心电图 典型病例 典型病例 药物治疗： ACEI：培哚普利 2.5mg qd 倍他乐克：6.25 mg bid 地高辛：0.25 mg qd 呋塞米：20mg bid 螺内酯：20mg bid 静脉间断应用：多巴酚丁胺、多巴胺 2010年心功能III-IV级心衰患者置入的I类适应证： （1）NYHA分级 III-IV级 （2）LVEF≤35% （3）QRS≥120 ms （4）窦性心律 （5）理想药物治疗后。 CRT治疗心衰又展新篇 4． 需常规起搏器治疗患者置入CRT适应证 I类适应证： （1）NYHA III-IV级 （2）LVEF≤35% （3）QRS≥120 ms IIa类适应证： （1）NYHA III-IV级 （2）LVEF≤35% （3）QRS＜120 ms IIb类适应证： （1）NYHA II级 （2）LVEF≤35% （3）QRS＜120 ms CRT治疗心衰又展新篇 * * * Main purpose: Illustrate for referral clinicians how the leads are placed to achieve cardiac resynchronization. Many outside the implant world may not be entirely aware of how the device is placed. Key messages: The implant procedure, while typically of longer duration, is similar to that of a standard pacemaker or implantable defibrillator implantation. A key difference is the placement of a left ventricular lead via the coronary sinus opening. Coronary venous anatomy varies significantly between patients. In a small percentage of cases it may not be possible to place the left ventricular lead transvenously. Some centers are opting for an epicardial approach if the transvenous approach is unsuccessful. Additional information: Standard pacing leads are placed in the right atrium and right ventricle. The LV lead is placed via the coronary sinus in a cardiac vein, preferably a lateral or postero-lateral vein in the mid part of the LV. The successful deployment of this lead to physician-guided development of left-heart delivery systems, and new LV leads to meet varying patient