肺动脉狭窄球囊扩张及支架植入病例报告薛浩课件.pptVIP

* * * * * * * * * * * * * * 经皮肺动脉狭窄血管内支架植入术（ percutaneous Intravascular stent Implantation of pulmonary branch artery stenosis ）  肺动脉狭窄球囊扩张 及支架植入病例报告 (影像及IVUS指导) 薛 浩；王广义；王峙峰; 冯 斌等 Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, CHINA 中国人民解放军总医院 How is pulmonary artery stenosis diagnosed? 1. a routine examination 2. abnormal heart sounds 3. abnormal sounds are identified 1.electrocardiogram (ECG) 2.chest X-ray 3.Doppler ultrasound 4.Cardiac magnetic resonance imaging (MRI) 5.64 MSCT 6.Perfusion scan 7.Pulmonary angiography Chinese PLA General Hospital How is pulmonary artery stenosis treated?1.balloon dilation2.balloon dilation and  stent placement3. the Cutting Balloon4. surgery Chinese PLA General Hospital 1983年Lock等首先在临床应用经皮球囊扩张血管成形术。肺动脉分支狭窄的球囊扩张术和其他球囊瓣膜和血管成形术相比较成功率低，并发症多，危险性大 Case1.女性，42岁球囊扩张前PAP150/50mmHg扩张后　　　　　　　　60/20mmHg病人自觉症状好转，心衰减轻 Chinese PLA General Hospital 经皮肺动脉狭窄-球囊扩张及血管内支架植入术（ percutaneous balloon?pulmonary?valvuloplasty and Intravascular stent Implantation of pulmonary branch artery stenosis ）临床常用的Palmaz Genesis支架及Cheatham Platinum支架等均为铂铱合金、钽或镍钛合金编织而成  Chinese PLA General Hospital 例1. 刘x，女性，29岁 1. 右心功能不全 “活动后气短 乏力 双下肢水肿2年” 半卧位 心率快（112次/分，律齐） 胸部杂音（胸骨左缘2、3、4肋间均可闻及3-4/6级收缩期杂音） 心包积液（中-大量），心包穿刺抽液 低氧—Pao2 76mmHg Pco2 31mmHg 于2005年6月13日入院 Chinese PLA General Hospital 2、心电图-右心负荷 Chinese PLA General Hospital 3. “右肺动脉狭窄” 1）PA突出，右心扩大 右心衰 2）右肺纹理减少 透光度增强 2005-6-14 入院后 Chinese PLA General Hospital 4. CT检查证实 Chinese PLA General Hospital CT 肺动脉造影证实 肺动脉压测定 Chinese PLA General Hospital High pressure balloon 8mm, atm 10 Chinese PLA General Hospital PA 3.2mm, Smart control nitinol stent 14x4mm Post-nitinol expandable stent Chinese PLA General Hospital -----------------------