LV lead 植入过程中静脉造影的重要性.pptx

LV lead 植入过程中静脉造影的重要性什么是静脉造影两维X线静脉解剖影像，通常在不同角度观测动态电影影像: 实时图像记录目 标在X线影像下辨认静脉解剖并描述其与电极导线放置的相关性 为什么要进行静脉造影 提供心脏静脉解剖的影像资料Provide a Visualization of Cardiac Venous Anatomy 增加电极导线植入的成功率 Increase Chance of Successful Lead Placement提供游离壁途径Access to lateral free wall提供静脉粗细和扭曲程度信息Insight into size and tortuosity of veins提供后备方案Provides a Back-Up Plan 提供理想左室电极位置的路线图Provides a roadmap to the optimal LV Lead position!!! 静脉造影造影球囊准备使用前要测试球囊使用1.25cc 预充针筒 - 粉红色管用肝素盐水冲洗白管球囊充气管（粉红色，带阀门）导管内腔（白色）静脉造影获得造影图像通过指引鞘管注入造影剂进行“冒烟”插入造影球囊超过指引鞘管头部2-3cm 确认无静脉夹层和CS大小注入少量造影剂 球囊充气，缓慢注入造影剂不同体位下造影并保留图像至少进行两个切面造影 (AP, LAO, RAO)放气并移去造影管 静脉解剖Venous Anatomy后静脉侧静脉侧静脉后外侧静脉静脉解剖的3维图像前外侧静脉心中静脉后静脉静脉造影三个体位AP最简单的观测切面Easiest perspective to see从前部到后部Shows front to backRAO可显示冠状窦的静脉分叉点Isolates vessels point of bifurcation from coronary sinus可显示心尖部到心底部的分离程度Reveals apical to basal lead separation(RV Lead)LAO可发现哪些静脉位于左室壁Isolates which veins are on left ventricular wall揭晓室间隔与外侧电极导线的分离程度Reveals septal to lateral lead separationLV 电极导线的松弛性Lead slackAP 视图From the AP view, ribs curve away from the spine with the same angulation on both sides（从AP视图，肋曲线相差的脊柱两侧具有相同的成角）* Click on object to run clipRAORAO视图: 观测… 脊柱在左侧 Spine on left 开胸手术后胸骨缝线在右侧Staples on right 脊突在左侧Spinal processes on left CS 在脊突右侧on right of spine 心影拉长Elongated heart shadow 电极导线位于脊柱右侧Leads to right of spineRAO View (Ribs)From the RAO view, ribs can be seen sloping downward as shown by the arrow (negative slope)从右前斜视图中,可以看到肋骨斜向下的箭头所示(负斜率)LAO: 观测What to look for…LAO 脊柱在右侧Spine on right 胸骨缝线在左侧Staples on left 脊突在右侧Spinal processes on right CS 横跨脊柱crosses spine 电极在脊柱左侧Leads left of spineLAO View (Ribs)From the LAO view, ribs can be seen sloping upward as shown by the arrow(positive slope)从左前斜视图中,可以看到肋骨斜向上的箭头所示(斜率为正)* Click on object to run clipLAO Venogram在两个或多个切面上的静脉造影图像减少血管重叠问题Reduce Vessel Overlap Issues 提供整体血管图像信息Provide Visualization of Entire Vessel 增进对解剖的理解Increased understanding of anatomy确定后外侧位置Ensure posterior lateral position多个切面的重要性RAO ViewLAO View目标