冠心病介入诊疗人工心脏起搏治疗心律失常介入诊疗先天性.ppt

房间隔缺损封堵 室间隔缺损封堵器材 经皮介入封堵治疗动脉导管未闭 （98% PDA 采用介入治疗） 心脏瓣膜病介入治疗 经皮穿刺球囊二尖瓣成形术 PBMV 经皮球囊肺动脉瓣成形术 PBPV 经皮球囊肺动脉瓣成形术 经皮球囊肺动脉瓣成形术 经皮球囊肺动脉瓣成形术 * * 经皮置换主动脉瓣膜－逆行法 先心病介入治疗发展趋势 先心病单一畸形到复合畸形的治疗 先心病的介入治疗趋于低龄化 介入治疗适应证将逐步扩展到复杂畸形 经导管瓣膜置换术将有突破性进展 二尖瓣关闭不全的介入治疗将被攻破 介入影像学将有革命性进步 肥厚梗阻型心肌病化学消融治疗 * Today’s dual-chamber devices can detect and treat bradyarrhythmias, as well as VT and VF. In addition, they can discriminate SVTs and other atrial tachyarrhythmias to reduce the incidence of inappropriate ventricular therapies, including inappropriate shocks. Very recently, the addition of atrial therapies (atrial tachyarrhythmia prevention, antitachycardia pacing (ATP), and cardioversion) to some of the very latest ICDs allows an additional level of therapy for VT/VF patients with atrial tachyarrhythmias. * Today’s devices are implanted pectorally, either subcutaneously or submuscularly in most patients. 1998 actual implants (estimates): 45,000 in U.S. 10,000 outside of U.S. 55,000 Worldwide Battery longevity projections for Medtronic devices: GEM 5.0 years – 100% pacing, monthly shocks 6.9 years – 100% pacing, quarterly shocks 9.1 years – 100% sensing, 0% pacing, quarterly shocks GEM DR 5.5 years – 100% pacing, monthly shocks 6.6 years – 100% pacing, quarterly shocks 7.8 years – 0% pacing, monthly shocks 9.6 years – 0% pacing, quarterly shocks Micro Jewel II 4.9 years – 100% pacing, monthly shocks 7.8 years – 100% sensing, 0% pacing, quarterly shocks Jewel AF 5.1 years – 100% pacing, monthly shocks 8.9 years – 0% pacing, quarterly shocks 其他冠心病介入技术： 1.高频旋磨术； 2.冠状动脉内定向旋切术； 3.腔内斑块切吸术； 4.激光冠状动脉成形术； 5.超声血管成形术； 6.冠状动脉内血栓抽吸术 冠状动脉粥样硬化性心脏病介入治疗 什么是心脏起搏器 它是通过发放一定形式的电脉冲刺激心脏并使之激动和收缩。即模拟正常的心脏的冲动形成和传导，以治疗由于某些心律失常或心脏病所致的心功能障碍的一种医用电子仪器。 作用实际上是提供人造的异位兴奋灶，以代替正常的起搏点来激动心脏。 其对于心肌的兴奋性和收缩功能丧失所致的心脏停搏则不起作用。 人工心脏起搏治疗 起搏器的历史 第一部导线经由静脉植入的人工心脏起搏器(1958年) 起搏器的进