慢性栓塞性肺动脉高压的手术治疗甘辉立.pptxVIP

北京安贞医院心外科 甘辉立;研究对象;第3页/共90页;第4页/共90页;PACTA: Mosaic pattern-diagnostic;Chest radiograph in a patient with chronic thromboembolic pulmonary hypertension. A, Note asymmetry of central pulmonary arteries, absence of descending left pulmonary artery, left lower lobe oligemia, and peripheral density representing prior infarct. B, Angiogram in the same patient demonstrates complete proximal occlusion of the descending left pulmonary artery.? ;The 5 distinct angiographic pattern of the CTEPH;Perfusion scans show pulmonary artery steal. A, Preoperative perfusion scan demonstrates minimal flow to the left lung. B, Perfusion scan obtained in the early postoperative period demonstrates dramatic reversal of flow with vascular “steal” from right lung. Equilibration and normalization of flow over time is the rule.? ;The CT venography;B mode ultrasonography;Venous ultrasonography;V/Q scan;ECG of a CTEPH;;Superficial vein thrombus and PE;Pulmonary angiogram;Pulmonary artery sarcoma;The therapy algorithm;Right pulmonary artery or a Tree?;The monkey is climbing the tree？Or surgeon doing PTE procedure？;;;手术前后：右心室功能马上改善;第24页/共90页;;第26页/共90页;第27页/共90页;引入概念——最近端病变哪种手术有意义？;;我们是如何作的;我们是如何作的;UPENN：脑电监测及逆行脑灌注;我们是如何作的;我们是如何作的;我们是如何作的;;我们是如何作的;UCSD是如何作的;关于出血的教训;国际国内现状;我们作到了哪些;我们作到了哪些;我们作到了哪些;;81例PTE手术总结;81例PTE手术总结;81例PTE手术总结;81例PTE手术总结;81例PTE手术总结;81例PTE手术总结;BNP的变化及右心室迅速重构;81例PTE手术总结;陈某，女，67岁，病史6年;陈某，手术过程及标本;陈某，术前（左）、术后（右）血流动力学;陈某，术后PACTA;PTE手术的难点;PTE手术的难点;肺栓塞的三个“三高”;目前存在的问题;肺缺血再灌注损伤过程;肺缺血再灌注损伤过程;肺缺血再灌注损伤过程;肺缺血再灌注损伤过程;Proximal type (single right lung);Proximal type (single right lung);Proximal type (single right lung);单肺PTE，对侧也出现再灌注损伤;单肺PTE，对侧也出现再灌注损伤;再灌注损伤的预防与治疗;Foamy bleeding type of LIRI;;ECMO;ECCO2R;再灌注损伤的预防与治疗;再灌注损伤的预防与治疗;PTE术后应用ECMO的第一例;PTE术后应用ECMO的第一例;辅助24小时，脱离ECMO，顺利出院 上了欧洲胸心血管外科杂志;术后残余肺动脉高压 ;肺动脉高压危相;肺动脉高压危相;肺动脉高压危相;肺动脉高压危相;团队合作;相关领域的工作基础 ;相关领域的工作基础;CTEPH组织标本分离的平滑肌细胞;CTEPH组织标本分离的平滑肌细胞鉴定结果;感谢您的观看！