心内超声和心电生理—英文课件.ppt

* These clips demonstrate imaging of the left ventricle with a large basal aneurysm. Note the catheter positioning in the border of the aneursym. Also, the image on the top right demonstrated microbubbles that can occur with over heating during RF ablation or open irrigation. 这些图片显示的是合并巨大基底动脉瘤的左室影像。注意导管的位置在动脉瘤边缘。 右上图显示在射频消融因局部过热产生的微泡 Translate directly This is a very rare anomaly in the left atrium, a common inferior os. ICE confirms a very posterior placement (upper clip) that was positioned adjacent to a large left upper pulmonary vein (lower clip). ICE helped direct placement of lesions in this very difficult anatomy. 这是一个很罕见的左房，常见的低位开口。ICE证实后位开口（上图）及巨大的左上肺静脉（下图）。 ICE能直接的显示这类复杂解剖病例的病变部位 ICE can help confirm and distinguish the LAA from the LSPV via direct visualization and confirmed with doppler imaging. This can prevent inadvertent manipulation in the LAA that increase the risk of perforation. ICE能在直视或多普勒超声影像下区分左心耳及左上肺静脉 这可以减少不适当的左心耳操作，从而减少左心耳穿孔的风险 * ICE can help size and position array catheters or balloons. Doppler imaging can help confirm proper placement. ICE能帮助定位ARRAY导管的大小及位置。多普勒超声能进一步证实位置的准确性 * The right pulmonary veins can be viewed in cross section (left clip) or longitudinally (right clip with posterior tilt into the intraatrial septum). 右侧肺静脉的横切面（左图）及纵切面（右图）可通过房间隔后斜进入而显示 * We anticoagulate aggressively during our left atrial procedures with therapeutic INRs (2-3) and ACTs 350sec to prevent thrombus formation on mapping and ablation catheters. Aggressive anticoagulation underscores the need to be sure that transseptal puncture and movement of catheters endocardially is performed properly. If thrombus does form, it can be visualized and removed with either retraction into the sheath or pulled directly back into the right atrium. 在左房手术中，我们抗凝较积极，维持INR在2-3， ACTs 350s以防止在标测及消融导管上的血栓形成。 低于该标准的抗凝则需要房间隔穿刺以及心内导管的操作很精确。 如果血栓形成则在ICE能看见并能回缩至鞘内或者直接拉回右房 Overheating can result in excessive endothelial disruprtion (left clip) that can subsequently to th