TOF病理生理及术前处理.pptVIP

Chest Radiography the heart size is generally normal, and the pulmonary artery segment may be small “boot-shaped” heart The aortic arch is right-sided in approximately 25 % of patients Echocardiography The diagnosis is generally easily established by echocardiography The typical malalignment VSD with aortic override and RVOTO is well visualized Often, the location of the LAD can be determined by transthoracic echo by following the left main coronary artery until it bifurcates If the anatomy of the peripheral pulmonary arteries is not well seen, cardiac MRI or catheterization can be useful for clarification Cardiac Catheterization In the majority of patients, diagnostic cardiac catheterization is not necessary Catheterization is more commonly used for interventional procedures before and after TOF repair to address branch pulmonary artery stenoses In the rare instance when the coronary artery anatomy is not well delineated by echocardiography, cardiac catheterization may be of benefit Cardiac Catheterization In TOF with pulmonary atresia and MAPCAs, catheterization is essential for delineating the pulmonary artery and aortopulmonary collateral anatomy for surgical planning Adult patients with repaired TOF may require cardiac catheterization if there is concern for coronary artery disease or prior to pulmonary valve replacement Cardiac MRI It provides excellent detail and specific flow data and can quantify myocardial function and percentage of pulmonary valve regurgitation Most commonly, cMRI is used in TOF to provide follow-up imaging after repair However, gadolinium-enhanced MR angiography is becoming a critical adjunct to the preoperative workup of TOF patients specifically with branch pulmonary artery anomalies or aortopulmonary collaterals and can function as a 3D “road map” for surgical planning Because cMRI requires patient cooperation (breath-holding and lying still), pediatric patients often require general anesthesia Therapy Medical Management Initial