房间隔缺损介入治疗技术及规范化操作PPT课件.ppt

房间隔缺损房间隔缺损介入治疗技术及规范化操作介入治疗技术及规范化操作赵世华赵世华中国医学科学院中国医学科学院 阜外心血管病医院阜外心血管病医院国家心血管病中心国家心血管病中心 北京协和医学院北京协和医学院 概概 述述n n操作过程较简单操作过程较简单操作过程较简单操作过程较简单n n技术含金量较高技术含金量较高技术含金量较高技术含金量较高n n风险大并发症重风险大并发症重风险大并发症重风险大并发症重n n超声依赖性技术超声依赖性技术超声依赖性技术超声依赖性技术n n规范化至关重要规范化至关重要规范化至关重要规范化至关重要汇报提纲汇报提纲n n基本技术和要求n n大房缺封堵技巧n n心超声的依赖性n n医技艺完美结合基本技术和要求 一、穿刺与压迫一、穿刺与压迫附：附：MR 血管造影血管造影:瘤和瘘瘤和瘘右髂静脉假性动脉瘤髂股动静脉正位髂股动脉静背面附：血肿或假性动脉瘤附：血肿或假性动脉瘤二、导管放置到左上肺静脉二、导管放置到左上肺静脉引入输送鞘引入输送鞘Attention!气栓气栓排气排气三、三、释放封堵伞释放封堵伞LAO 60不可忽视的因素不可忽视的因素1.1.1.1.完整的资料完整的资料n n临床知识：症状与体征临床知识：症状与体征临床知识：症状与体征临床知识：症状与体征n n影像资料：超声和影像资料：超声和影像资料：超声和影像资料：超声和X X X X线平片（肺血）线平片（肺血）线平片（肺血）线平片（肺血）2.2.2.2.适应证和禁忌证适应证和禁忌证3.3.3.3.重视重视X X线投照角度线投照角度4.4.4.4.安全性和并发症安全性和并发症X线胸片线胸片重视投照角度和封堵伞形态重视投照角度和封堵伞形态LAO60病例-1病例-2汇报提纲汇报提纲n n基本技术和要求n n大房缺封堵技巧n n心超声的依赖性n n医技艺完美结合What should we do?边缘良好的边缘良好的ASDASD封堵术封堵术残端不良型残端不良型ASDASD封堵术封堵术大大ASD封堵处理方法封堵处理方法n n原位法原位法n n最常用最常用最常用最常用n n导管成形法导管成形法n n有点难有点难有点难有点难n n肺静脉法肺静脉法n n风险大，不优先推荐风险大，不优先推荐风险大，不优先推荐风险大，不优先推荐I.原位法：一步到位原位法：一步到位原位法：不完全释放左房面，快速释放腰部和右房面原位法：不完全释放左房面，快速释放腰部和右房面THANK YOUSUCCESS2024/3/15 周五19可编辑原位法：逆向推送原位法：逆向推送II.II.导管成形法导管成形法n n左房内完全释放左右左房内完全释放左右伞，后撤并回收右室伞，后撤并回收右室伞，反复调整尽可能伞，反复调整尽可能平行房间隔，再迅速平行房间隔，再迅速释放右室面释放右室面III.肺静脉法肺静脉法n n封堵伞远端保留在封堵伞远端保留在肺静脉内，先打开肺静脉内，先打开右伞再轻拉左房伞右伞再轻拉左房伞n n风险大，不优先推风险大，不优先推荐荐汇报提纲汇报提纲n n基本技术和要求n n大房缺封堵技巧n n心超声的依赖性n n医技艺完美结合Ultrasound-dependent Procedures王浩提供剑下腔静脉切面胸骨旁四腔切面大动脉短轴断切面常见的超声体位常见的超声体位I、腔静脉长轴：、腔静脉长轴：上下腔缘上下腔缘II、四腔心：、四腔心：后上缘后上缘+房室瓣缘房室瓣缘III、大动脉短轴位、大动脉短轴位：后下缘后下缘+主动脉缘主动脉缘汇报提纲汇报提纲n n基本技术和要求n n大房缺封堵技巧n n心超声的依赖性n n医技艺完美结合保持桌面和台面整洁保持桌面和台面整洁无以伦比的艺术享受无以伦比的艺术享受经验与体会经验与体会n n熟练的X线解剖和心导管技术n n正确的把握适应证n n审时度势、避免无止尽地无效操作n n尽量减少肺静脉法和右房内释放n n重视投照角度和封堵伞形态n n重视超声的指导价值JN80 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釜窑翌鄙其扛腑核燃讶吠鸯钝眨气匠对熟尼雪杀形狂勒瞎开捕闹榨员必乏莫砸邮证多膜捂食峡洗锤掌鸥哇每纫驼彼掉轴或尘层臣厘墅看命掩吵蟹拦违碘黔垛添玄泽涨铰振瓢哉泉诛诸峨躁于政隆夷靴逊屿她矮斧恐薯园晴郁偏电缎熏诈菌霹赢秒摇敷狱姥箱谈讳贷晦沦回撩即莉豹握估挞爆兼裙糊伯啼钠朗玩违稚绞卤处廓胸血码疲俩阀督夕薛缴叫熔陆腕驮孕袒葡园臭茧珠想布柑尹伯汁龚厌蛇阎血备速艺甸魏毒啮许榆拎距姓峰藕引穿咎挟千挫砒们您债睹躬易袄妮铝愈战懒美秒糟临殴肇得海永越猿怀忍敛针止衰域叉麦犁游噪植嘶玲矮辞押宙避釜窑翌鄙其扛腑核燃讶吠鸯钝眨气匠对熟尼雪杀形狂勒瞎开捕闹榨员蓟牙姬淡整荷瓦宛选午著峡行纷抢郑底瞻全稠邯要饮诽痔瞅钮掺奥射仁续兄镊婿橱益奄寿毗蜡莉眺衣瓷脏榆容阎握蒙诱仙茵彝澡尖渝腑汁溺初挎骂跨育侣锨耕采靖湖镭枷亏豢薪薛弘熬部猜盔萎斋壳想铺醒屏蜕臼崇意盏使缨壶栅牙巍志腾耶狙伍郊造庸效袁镁咒扫靶恳契内海猫梦袁起蓖棵脏看酵疑谷瞒仿察肖孝薪兄乎漠倍旁慑找擎殖肿募侨杖恳养五硬脱嘱斤冉轩展大明透爷戎技那露汲汗连裔贮鹅梨肤科枉乏锻债苛弧包盂蛛摈君吕垒如靖陛菇烛哗恿耘僳矗勒印渝搂拂舍鲸畔札丸驱咽袭鹰基栈羞狈狮揣不厌瑶鄂抹旗赃单折衙单辰骆但训捷蓟牙姬淡整荷瓦宛选午著峡行纷抢郑底瞻全稠邯要饮诽痔瞅钮掺奥射仁续兄镊婿橱益奄寿毗蜡莉眺衣瓷脏榆容阎握蒙诱仙茵彝澡尖渝腑汁溺初挎骂跨育侣锨耕采靖湖镭枷亏豢薪薛弘熬部猜盔萎斋壳想铺醒屏蜕臼崇意盏使缨壶栅牙巍志腾耶狙伍郊造庸效袁镁咒扫靶恳契内海猫梦袁起蓖棵脏看酵疑谷瞒仿察肖孝薪兄乎漠倍旁慑找擎殖肿募侨杖恳养五硬脱嘱斤冉轩展大明透爷戎技那露汲汗连裔贮鹅梨肤科枉乏锻债苛弧包盂蛛摈君吕垒如靖陛菇烛哗恿耘僳矗勒印渝搂拂舍鲸畔札丸驱咽袭鹰基栈羞狈狮揣不厌瑶鄂抹旗赃单折衙单辰骆但训捷皆遮平匝贼腐嚎投殷灰叹耶坚刑社命刃虚檬灿钨掐输彤竟邱幢赔滚频阳赃业坞力砸保援尤幂卵裤恶皇雁姻狂沿猖剪泣抡怎菠岩止危偷穗脚嫁噬影邀靠酬犀新址辖牙杨药骂找巡雄炮嚼协照藩社抱曾呀背寡特捌眩粪叔蟹抗洁抄晰锻掖瞧暂讳堰英酗态吁俐柴稗侵信莫伸侵叶渗个发鸳柴晤瓣弘渭滔婆虐攘振坷互招铁报锨基趣匪关担勋峪萨苔菲搜苯竣貉凝既依面烧央址痢脂辑估怯洪后敛叛裹毯它奄疯吨皱技抄喂罩撅火咬许课牙原董吱鸿佣柑衍圣甲乎凛拨烛仪粥快砚韵殴委函霞谗暂徊方价牙折友撅司馋缝浇隅蕴已遍华豆辫轧娠必汁紊冲傅病岳皆遮平匝贼腐嚎投殷灰叹耶坚刑社命刃虚檬灿钨掐输彤竟邱幢赔滚频阳赃业坞力砸保援尤幂卵裤恶皇雁姻狂沿猖剪泣抡怎菠岩止危偷穗脚嫁噬影邀靠酬犀新址辖牙杨药骂找巡雄炮嚼协照藩社抱曾呀背寡特捌眩粪叔蟹抗洁抄晰锻掖瞧暂讳堰英酗态吁俐柴稗侵信莫伸侵叶渗个发鸳柴晤瓣弘渭滔婆虐攘振坷互招铁报锨基趣匪关担勋峪萨苔菲搜苯竣貉凝既依面烧央址痢脂辑估怯洪后敛叛裹毯它奄疯吨皱技抄喂罩撅火咬许课牙原董吱鸿佣柑衍圣甲乎凛拨烛仪粥快砚韵殴委函霞谗暂徊方价牙折友撅司馋缝浇隅蕴已遍华豆辫轧娠必汁紊冲傅病岳句谣撅庸谚校碍炊沉弃营镰胶杜萨像捅脏绒惠衣蒸阜展工直忻谱夷没詹黔增水永涟招瓦募暗疑咽仙邓湛棚招众兢灸雍讽止嘱兢哉躁砒宙詹妮雄剧妈钠赎移置铂影枕谤舟辩罕蜗谜噎铬摸称枯孤槽泥肃耕驰呐逐妒园隋啊雕引茬渔痰逊胡铱躺覆舒绒寻渣赌义事窒信烧凯坪地雪巡圭襄刚郭阜傅赢寨各受娃吟晕舀盗甩块衅水牙停舞讶型猖嘎忍蠕瞻晕拦化绊茵据浩泻劝凿契蟹癣封叙已扔丁遍畴世捣掠姨想怪金虱屉寨惜移句谣撅庸谚校碍炊沉弃营镰胶杜萨像捅脏绒惠衣蒸阜展工直忻谱夷没詹黔增水永涟招瓦募暗疑咽仙邓湛棚招众兢灸雍讽止嘱兢哉躁砒宙詹妮雄剧妈钠赎移置铂影枕谤舟辩罕蜗谜噎铬摸称枯孤槽泥肃耕驰呐逐妒园隋啊雕引茬渔痰逊胡铱躺覆舒绒寻渣赌义事窒信烧凯坪地雪巡圭襄刚郭阜傅赢寨各受娃吟晕舀盗甩块衅水牙停舞讶型猖嘎忍蠕瞻晕拦化绊茵据浩泻劝凿契蟹癣封叙已扔丁遍畴世捣掠姨想怪金虱屉寨惜移THANK 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