杂交技术在肌部室间隔缺损治疗中的应用.ppt

. Technique—pathway establishment a purse-string suture at the location, puncture with a 20 gauge needle, guidewire was introduced into the LV through the defect under TEE A deliver sheath was advanced over the wire into the LV, then the device was delivered through the sheath. Technique--occluder Muscular occluder PDA occluder (for apical defect) Follow-up TTE and ECG at discharge and 6 months after discharge; Any residual shunt, arrhythmia or new valve problem would be recorded. 病例4：MVSD×4+ASD 9月，6kg，重度PH 4个MVSD、合并ASD 使用3枚MVSD封堵器、1枚 ASD封堵器，全部封堵成功 4个MVSD中，有3个缺损彼此相邻 病例4：MVSD×4+ASD 需要预先建立两个轨道 第一个鞘管进入并封堵室缺 第二个鞘管进入并封堵室缺 封堵第三个室缺 图中见2枚MVSD伞和ASD伞 图中见3个肌部伞 手术后X光片见3枚肌部VSD伞和ASD伞 讨论 经皮介入封堵存在的不足 １）受病人年龄和体重的限制 ２）对外周血管潜在的损伤 ３）室缺靠室隔前份或心尖时，经皮封堵失败的可能性大 ４）存在射线照射对婴幼儿的影响 讨论 心室穿刺封堵术的优势有: 1）操作灵活、准确放伞 2）封堵器收放容易便于选伞 3）实时评估疗效，减少残余漏；合理选伞 讨论 4）合并其他畸形时，如封堵成功，可明显缩短体外循环时间；单纯MVSD可避免体外循环 5）避免心室切开，保护右室功能，减少心律失常的发生 讨论 □超声心动图的重要性 １）术前超声检查； ２）TEE在穿刺点选择中的引导作用； ３）TEE在轨道建立过程中的引导作用； ４）超声在评估中的作用 超声医生-外科医生的配合保证手术的成功 超声医生对外科的理解 外科医生对图像的理解 两者的结合：经超声医生的手得到图像 经外科医生的手实施操作。 结论 经心室穿刺封堵MVSD是一种安全、有效和微创的治疗手段，其短期效果满意 经心室穿刺与经皮介入封堵肌部室缺相比，基本不受患儿年龄及缺损位置限制，且选伞灵活 其远期效果，如心律失常、心室功能的远期影响尚有待进一步观察 谢 谢 英文版 The application of hybrid technique for muscular ventricular septal defects Ying-kang Shi, Qi An Department of Thoracic and Cardiovascular Surgery West China Hospital, Sichuan University Background Surgical repair of MVSD: poor exposure, chance of ventriculotomy, and high incidence of residual shunt; Transcatheter closure: limited by vessel condition in young children needing early intervention; Transcatheter closure: minimally invasive, but hard to establish the pathway and the success rate is lower. Background Perventricular device closure (PDC) may be the third choice and probably provides part of the patients a chance to get minimally invasive treatment compared to on-pump surgery Patients Methods May 2007 to July 2009, thirteen patients with single or multip