外科学教学课件：Heart Disease.ppt

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Thank You * * * * * * * * * * * * * * * * * * * * * * * * * * * Diseases of the Great Vessels Aneurysm， Dissection， Pseudoaneurysm Aortic Dissection Thoracic aortic dissection occurs as blood flow is redirected from the aorta (true lumen) through an intimal tear into the media of the aortic wall (false lumen). A dissection plane that separates the intima from the overlying adventitia along a variable length of the aorta is created within the media. The acute form of aortic dissection is often rapidly lethal, while those surviving the initial event go on to develop a chronic dissection with more protean manifestations CLASSIFICATION ? DeBakey ：I / II / III a / b Stanford A / B Treatment Stanford A Surgery Stanford B Medical therapy or endovascular Stent Standford B 型 Chimney Technique 三个月瘤腔稍变小 Tetralogy of Fallot (TOF) The combination of a VSD with Pulmonary Stenosis, with the Aorta Overriding (sitting astride) the VSD and with RV Hypertrophy is termed Tetralogy of Fallot. The obstruction to flow into the lungs leads to blood being diverted through the VSD to the aorta. Flow in the lung circulation is reduced and the child appears Blue (Cyanosed). These defects cause the child to be cyanotic (bluish color to the lips, nailbeds and skin). This is caused by blue blood, low in oxygen, from the right ventricle passing through the VSD directly into the aorta and then to the body. Less than normal amounts of blood go to the lungs because of the obstruction from the pulmonary stenosis and smaller size of the pulmonary artery. Treatment Anatomic correction of the malformation Relieving the obstructuon of right ventricular outflow tract, pulmonary annulus and pulmonary artery. By resecting infundibular area muscle and/or enlarging with a patch. Closing VSD with a patch of prosthetic material. Palliative Procedure The Blalock-Taussig (subclavian-pulmonary) shunt. Surgical Treatment of V