复杂先天性心脏病的镶嵌治疗课件

Interventional Cardiac Catheterization Combined with Cardiac Surgery for Complex Congenital Heart Disease Zhiwei Zhang, MD (张智伟) Guangdong Provincial Cardiovascular Institute The combined approach : A joint procedure involving intervention and surgery Staged therapy for complex disease Proven clinical effectiveness and safety Some procedures even become the standard treatment for specific congenital heart disease Transcatheter intervention before surgery Intraoperative transcatheter intervention (Hybrid approach) Transcatheter intervention after surgery Transcatheter Intervention before surgery Transcatheter atrial septostomy Aortopulmonary collateral arteries occlusion Aortopulmonary shunt occlusion Radiofrequency or Laser-assisted pulmonary valvotomy and balloon valvuloplasty Transcatheter atrial septostomy TGA/IVS HLHS 、MA HRHS、TA PA/IVS TAPVC BAS Atrial septostomy in a fetus with HLHS RA LA Aortopulmonary collateral arteries occlusion before operation Occlusion of collaterals in a TOF case with RVOT reconstruction and 2 days later the case underwent surgical total correction Radiofrequency or Laser-assisted pulmonary valvotomy and balloon valvuloplasty PA/IVS Early establishment of continuity between the right ventricle with pulmonary trunk Decompressive the hypertensive right ventricle Promote growth of right ventricle As alternative to surgical treatment Effective in establishing RV-PA continuity Much lower immediate mortality and morbidity Improved outcome Radiofrequency or Laser-assisted pulmonary valvotomy and balloon valvuloplasty 图片 电影 Intraoperative transcatheter intervention lIntraoperative stenting of pulmonary arteries or veins lVentricular device closure of muscular ventricular septal defects lPercutaneous approach to completion of total cavopulmonary connection or the Fontan circuit lHybrid approach in the treatment of hypoplastic left heart syndrome Intraoperative Stenting of Branch Pulmonary Arteries Limitations of Stent Implantation in Catheterization Laboratory 1. Large delivery sheaths 2. Limited vascular access 3. Small size of patients 4. Concommitant surgical procedure required Chest X-ray after procedure Hjortdal VE, European Journal of Cardio-thoracic Surgery 22 , 885890 With the patient on cardiopulmonary bypass, a stent was implanted in the stenotic left pulmonary artery under direct vision. Hybrid Approaches To HLHS 请俊杰根据原文补充 Balloon Angioplasty or endovascular stents for residue vessel stenosis Occlusion of duct after Fontan procedure Occlusion of residue ventricular septal defect Valve stent implantation Interventional techniques after surgery B-T conduit stenosis Stent implantation Balloon angioplasty for residue stenosis of LPA and RPA Stent implanting for LPA stenosis VSD occlusion in a patient after palliative Switch procedure. Valve stent implanting Bonhoeffer P, et al. J Am Coll Cardiol. 2002;39:16641669 l Interventional catheterization has become an important treatment modalities for complex congenital heart disease. l The combined approach plays an important role in the management strategies of complex congenital heart disease. Mortality, morbidity can be decreased and outcomes can be improved. l The combined approach further increase the collaboration between cardiac surgeons and paediatric cardiologist in providing an effective, safe and efficient kind of treatment to patients with complex congenital heart disease. That are difficult, if not impossible, to