心脏外科学讲义英文版

1、Heart SurgeryWuChangXue Dept of thoracic cardiovasclar surgery,LZMCCHDPA blood increasePA blood decreaseOther abnormalities of conotruncusOther abnomaliesPA blood increaseBlood shut from left heart system to right at atrial, ventricular or great artery levellPDAlASDlVSDlAV canal defectPDA-Patent duc

2、tus ateriosuslrole of ductus arteriosuslLocationlRecurrent laryngeal nervelFail to close after 3 months FunnelPhysiology of PDAL R shuntPA blood increaseLV volume overloadComplication: aneurism, IE, calcification, pulmonary vascular disease PA hypertensionLV enlargementDiagnosis of PDAlBody sign: co

3、ntinous machinery murmur SBP-DBP increase LV enlargelElectric cardiographylEchocardiographylX-raylCardiac catheterization Treatment of PDAClosure OfPDAComplication of PDA ligationlBleedinglRecurrent laryngeal nerve injurylAneurism lReopenlReflective high blood pressurelotherASDlPremum partial atrial

4、 ventricular canal defectlSecundem ostium SVC IVC mixed CSPathophysiology of ASDlL-R shuntinglPulmonary hypertensionlP vascular dislEisenmenger syndromeDisgnosis of ASDlPhysical exam: SM, P2lSubtle sign of heart failure: exercise ,palpitation,arrhythmiaslEcho CGl Electric CGlcatheterizationtreatment

5、lPFO:80% spontaneous closure in 1st.lclosure for :symppomatic patients significant ASD L-R shunt over 1.5:1lClosure way: surg percutaneous transcatheter device transthoracic catheter device transthoracic scope assisted VSDlPerimembranouslMuscularlSubarterial lAtrioventricular Pathophysiology of VSDl

6、L-R shuntingl P blood increaselLV volume overloadlPHlEisenmenger syndromeDisgnosis of VSDlPhysical exam: SM, P2lSubtle sign of heart failure: exercise intolerance,palpitation, arrhythmiaslEcho CGl Electric CGlcatheterizationTreatment lSpontanous clsourelclosure for :symppomatic patients large VSDlCl

7、osure way: surg percutaneous transcatheter device transthoracic catheter device transthoracic scope assistedSurg for VSDlHeart incisionlPatchlComplicationTOFlVSDlAortic overidinglRVOTOlRV hypertrophyl combined abnormalities Disgnosis of TOFlClinical: symptoms( cyanosis, anoxia spell, exercise intole

8、rance, squat ) body sign( dysplasia, cyanosis, pestle loke finger , heart check)lX-ray: boot shapelEcho CGl Electric CGlcatheterizationRescue for TOF spelllKnee-to-chest lOxygenlSedation: morphinelVolume expansionlIncrease cardiac preload and systemic resistanceSurgery for TOFlTwo stage: classic and

9、 modified blalock-taussing shuntlSingle stage: VSD closure+ RVOTO reliefValve DiseaselCongenitallRheumaticlDegenerativelInfectionlImmuneMitral valve stenosisMSlValvular lesions free edge echo intensity, thickening, valvular adhesion, opening area is reduced： minor：1.52.0 cm2 moderate：1.01.5 cm2 seve

10、re：1.0 cm2PpvWhole heart failureMSPGa-vPHRV LA RV failureLV failureClinical ManifestationslSymptoms (1) Dyspnea: The earliest symptoms; (2) hemoptysis, bloody sputum; (3) cough; (4) hoarseness;l(Signs (1) mitral valve face. (2) signs of heart mitral stenosis; apex beat is not obvious; S1 loud; DM. (

11、3) pulmonary hypertension and right ventricular dilatationEchoNMsNMsAortic stenosis（AS） EtiologylCongenital: Congenital hypoplasia of the aortic valve, two lobes or multiple lobes; subvavular located stenosis;lAcquired: rheumatic or senile degenerationPathology and hemodynamic changeslAn aortic valve itself increased pressure loadASLVHLHFIncrease in myocardial oxygen consumption Intracardiac diastolic pressureCoronary perfusionMyocardial ischemiaClinical InfestationlSymptoms: Dyspne