实时三维超声心动图叶维国PPT课件

1、完整关护周期新理念完整关护周期新理念 家庭照顾家庭照顾第1页/共63页第2页/共63页第3页/共63页经皮心腔内介入治疗经皮心腔内介入治疗 二尖瓣外科治疗二尖瓣外科治疗 (二尖瓣狭窄二尖瓣狭窄/二尖瓣脱垂二尖瓣脱垂/连枷瓣连枷瓣 / 缺血性二尖瓣反流缺血性二尖瓣反流) 经皮二尖瓣钳经皮二尖瓣钳MitraClip system 经皮二尖瓣球囊扩张术经皮二尖瓣球囊扩张术(PBMV) 监测二尖瓣修复监测二尖瓣修复/置换外科手术后监测效果置换外科手术后监测效果 经皮主动脉瓣置换经皮主动脉瓣置换 房间隔缺损房间隔缺损/卵圆孔封堵卵圆孔封堵 左心耳封堵左心耳封堵第4页/共63页Robert Lang 医生

2、惠赠医生惠赠University of Chicago第5页/共63页Robert Lang 医生惠赠医生惠赠University of Chicago第6页/共63页Robert Lang 医生惠赠医生惠赠University of Chicago第7页/共63页经皮二尖瓣钳经皮二尖瓣钳(EValve)第8页/共63页Vahanian 及及 Brochet医生惠赠医生惠赠Bichat Hospital, Paris, France二尖瓣狭窄经皮球囊扩张术二尖瓣狭窄经皮球囊扩张术第9页/共63页扩张前扩张后Vahanian 及及 Brochet医生惠赠医生惠赠Bichat Hospital,

3、Paris, France第10页/共63页第11页/共63页二尖瓣机械瓣开裂二尖瓣机械瓣开裂: : 左心房面左心房面二尖瓣机械瓣二尖瓣机械瓣主动脉瓣机械瓣主动脉瓣机械瓣第12页/共63页三维彩色血流示瓣周漏三维彩色血流示瓣周漏倾斜的左心房面倾斜的左心房面: 三维血流束定位三维血流束定位左心室面左心室面: 有效的反流口面积有效的反流口面积第13页/共63页面积面积 = 0.51 cm2第14页/共63页第15页/共63页Garcia Fernandez医生惠赠医生惠赠, Spain第16页/共63页术前术前第17页/共63页术后术后第18页/共63页第19页/共63页Robert Lang 医

4、生惠赠医生惠赠University of Chicago第20页/共63页上腔静脉上腔静脉三尖瓣三尖瓣主动脉主动脉房间隔缺损房间隔缺损: 外科医生切面外科医生切面 Robert Lang 医生惠赠医生惠赠University of Chicago第21页/共63页经食管超声图像经食管超声图像经心腔内超声图像经心腔内超声图像从右心房侧从右心房侧 从左心房侧从左心房侧 第22页/共63页Robert Lang 医生惠赠医生惠赠University of Chicago第23页/共63页封堵器位置评价封堵器位置评价Robert Lang 医生惠赠医生惠赠University of Chicago左心

5、房伞左心房伞右心房伞右心房伞第24页/共63页三维经食管超声心动图介入术中应用三维经食管超声心动图介入术中应用惠赠惠赠第25页/共63页正视切面正视切面89 %Robert Lang 医生惠赠医生惠赠University of Chicago第26页/共63页LAA sideLA sidePTFE membraneNitinolFrameAnchorsLA sideLAA sideBarbsNitinol framePolyethylene membrane第27页/共63页第28页/共63页Conclusions 在过去在过去20年中，三维超声心动图取得了革命性的进步，促进了疾病早期筛查、诊

6、断、治疗引导和效果监测年中，三维超声心动图取得了革命性的进步，促进了疾病早期筛查、诊断、治疗引导和效果监测 技术不断进步将继续惠及患者技术不断进步将继续惠及患者第29页/共63页第30页/共63页第31页/共63页 Gabriel Yip, MD FASE FACCAssociate Professor, Division of CardiologyDepartment of Medicine & Therapeutics The Chinese University of Hong KongPrince of Wales Hospital, Hong Kong, China第32页/

7、共63页 up Home Care第33页/共63页LV Geometry, Function and MassLV Regional and Dyssynchrony AssessmentRV volumes and functionAtrial volumesValvular heart disease Mitral valve (MS/MVP & Flail/ Ischemic MR) Aortic Stenosis, Tricuspid Valve DiseaseGuiding percutaneous interventions第34页/共63页LV Geometry, Fu

8、nction and MassLV Regional and Dyssynchrony AssessmentRV volumes and functionAtrial volumesValvular heart disease Mitral valve (MS/MVP & Flail/ Ischemic MR) Aortic Stenosis, Tricuspid Valve DiseaseGuiding percutaneous interventions第35页/共63页Percutaneous Intracardiac Intervention Mitral Valve Surg

9、ery (MS/MVP Flail/ Ischemic MR) Percutaneous MitraClip system Percutaneous balloon mitral valvuloplasty (PBMV) Monitor surgical outcome after repair/replacement Percutaneous aortic valve replacement ASD/PFO closure Left atrial appendage occlusion第36页/共63页During-SurgeryCourtesy: Dr. Robert LangUniver

10、sity of Chicago第37页/共63页Bileleaflet Mechanical ProsthesisCourtesy: Dr. Robert LangUniversity of Chicago第38页/共63页Stenotic Bioprosthetic MVCourtesy: Dr. Robert LangUniversity of Chicago第39页/共63页Percutaneous MitraClip (EValve)第40页/共63页Courtesy of Dr Vahanian and Dr BrochetBichat Hospital, Paris, France

11、PBMV in Mitral Stenosis第41页/共63页PBMV in Mitral StenosisCourtesy of Dr Vahanian and Dr BrochetBichat Hospital, Paris, France第42页/共63页Heart Failure Symptoms 3 months S/P MVR+AVR第43页/共63页Dehiscence of Mitral Prosthesis: Left Atrial PerspectiveMitral prosthesisAortic prosthesis第44页/共63页Oblique LA perspe

12、ctive: 3D Jet orientationLV perspective: Effective regurgitation orifice area第45页/共63页Area = 0.51 cm2第46页/共63页Percutaneous Repair of Prosthetic Mitral Valve Dehiscence第47页/共63页Percutaneous Repair of Prosthetic Aortic Valve Dehiscence第48页/共63页Before implantation第49页/共63页Post implantation第50页/共63页Pate

13、nt Foramen OvaleCourtesy: Dr. Robert LangUniversity of Chicago第51页/共63页Patent Foramen OvaleCourtesy: Dr. Robert LangUniversity of Chicago第52页/共63页SVCTVAOASD: The Surgeons View Courtesy: Dr. Robert Lang, University of Chicago第53页/共63页ICE imageTEE imageView from RAView from LAGuidewire and Sheath Plac

14、ementCourtesy: Dr. Robert LangUniversity of Chicago第54页/共63页Device Deployment第55页/共63页Evaluation Device PositionRA discLA disc第56页/共63页Peri-interventional 3D TEEPFO Closure第57页/共63页Left Atrial Appendage(LA view)En-face view89 %第58页/共63页Left Atrial Appendage OccluderLAA sideLA sidePTFE membraneNitinolFrameAnchorsLA sideLAA sideBarbsNitinol framePolyethylene membrane第59页/共63页第60页/共63页Conclusions Over past 20 years, remarkable evolution in 3D