先天性心脏病封堵治疗基础超声影像

先天性心脏病封堵治疗

基础超声影像陈良龙MDPhDFACCUUFightingCVD7/8/20261LLCHENMDPhDFACC导管室彩色多普勒超声的作用

术前诊断/术中监测/术后评价介入治疗引导监测先天性心脏病—封堵治疗瓣膜性心脏病—扩张成形肥厚型心肌病—消融治疗扩张型心肌病—同步治疗急诊胸痛病因鉴别急性冠脉综合征主动脉夹层血肿急性肺动脉栓塞重症心肌心包炎严重张力性气胸导管并发症早发现心包填塞心脏破裂接触血栓腔内气栓术后疗效评价优化影像形态学评估血流动力学评估器械是否需更换术式是否需改变术后治疗关注点7/8/20262LLCHENMDPhDFACCS1

术中引导监测7/8/20263LLCHENMDPhDFACC1.导管房间隔缺损封堵术7/8/20264LLCHENMDPhDFACC术前ASD超声评估ASD位置/形态/数目选择合适ADO7/8/20265LLCHENMDPhDFACC心尖四腔观房间隔全长最大ADO缺损直径解剖扩张缺损边缘有无厚薄周围结构PVCSSVC\IVCMV\TVAB7/8/20266LLCHENMDPhDFACC剑下四腔观AB房间隔全长最大ADO缺损直径解剖扩张缺损边缘有无厚薄周围结构PVCSSVC\IVCMV\TV7/8/20267LLCHENMDPhDFACC心底短轴观主动脉对侧房缺边缘长度主动脉侧房缺边缘长度周围结构主动脉根部SVCMVAB7/8/20268LLCHENMDPhDFACC剑下下腔观AB房间隔缺损在IVC侧边缘残端有无厚薄IVC侧边缘无残端容易导致封堵失败7/8/20269LLCHENMDPhDFACC术中封堵器能否释放夹住房间隔残端的超声影像观察排除封堵器占位的超声影像观察7/8/202610LLCHENMDPhDFACC心尖四腔观:通过牵/拉输送系统确定房间隔前下/后上是否被封堵器夹住确定封堵器是否正常、移位。AB7/8/202611LLCHENMDPhDFACC剑下四腔观:通过牵/拉输送系统AB确定房间隔前下/后上是否被封堵器夹住确定封堵器是否移位7/8/202612LLCHENMDPhDFACC心底短轴观:通过牵/拉输送系统AB确定封堵器是否夹住主动脉侧房缺残端或抱住主A根部确定封堵器是否夹住主动脉对侧房缺残端7/8/202613LLCHENMDPhDFACC各切面观:排除封堵器占位二三尖瓣肺静脉冠状窦上下腔静脉AB7/8/202614LLCHENMDPhDFACC封堵效果好的超声影像观察术后ASD封堵效果观察7/8/202615LLCHENMDPhDFACC心尖四腔及大动脉短轴观补片位置和形态良好对二、三尖瓣无影响对肺静脉回流无影响良好环抱主动脉AB7/8/202616LLCHENMDPhDFACC2.经导管VSD封堵术7/8/202617LLCHENMDPhDFACC术前VSD超声评估VSD位置/形态/数目选择合适ADO7/8/202618LLCHENMDPhDFACC室间隔缺损的形态分类

管状窗状

囊袋型漏斗型

7/8/202619LLCHENMDPhDFACC心尖五(四)腔心切面室间隔缺损边缘距主动脉瓣距离与瓣环的距离与窦的距离窦脱垂室间隔缺损的形态长管状短窗型漏斗状囊袋状：多漏口，基底宽室间隔缺损与三尖瓣的关系囊袋状缺损与三尖瓣粘连三尖瓣粘连封闭缺损7/8/202620LLCHENMDPhDFACC左心室长轴切面室间隔缺损边缘距主动脉瓣距离与瓣环的距离与窦的距离窦脱垂室间隔缺损与三尖瓣的关系三尖瓣粘连封闭缺损囊袋状缺损与三尖瓣粘连7/8/202621LLCHENMDPhDFACC心底短轴切面室间隔缺损的位置脊下型，膜部，膜周部脊内型，脊上型，干下型室间隔缺损的大小右室流出道情况7/8/202622LLCHENMDPhDFACC术中VSD封堵超声监测封堵过程是否影响重要结构封堵效果及残余分流7/8/202623LLCHENMDPhDFACC心尖五（四）腔心切面观察输送导管穿过室间隔观察出鞘的封堵器是否影响二尖瓣腱索引起关闭不全7/8/202624LLCHENMDPhDFACC心尖五（四）腔心切面观察封堵器位置是否正常观察封堵器是否完全封堵缺损，是否有残余分流7/8/202625LLCHENMDPhDFACC心尖五（四）腔心切面观察封堵器是否引起主动脉瓣关闭不全是否触及主动脉窦是否影响主动脉瓣关闭观察封堵器是否引起三尖瓣关闭不全三尖瓣腱索被夹，断裂低血压7/8/202626LLCHENMDPhDFACC左室长轴切面观察封堵器是否引起主动脉瓣关闭不全，是否触及主动脉窦或引起主动脉窦变形7/8/202627LLCHENMDPhDFACC封堵效果与并发症术后VSD封堵效果观察7/8/202628LLCHENMDPhDFACC成功封堵封堵器位置良好无主动脉瓣返流无三尖瓣返流无主动脉窦变形可释放封堵器7/8/202629LLCHENMDPhDFACC3.超声引导PDA封堵术7/8/202630LLCHENMDPhDFACC测量PDA大小、观察其形态、选择封堵器Figure1.Theampullaandtheductconnectionbetweenthedescendingaortaandtheleftpulmonaryarteryinapatientwithamegaphone-likePDAwereclearlyvisualizedontheparasternalshortaxisview,andMDDof4.3mmand4.5mmwasaccuratelymeasuredin2DEimage(1A)andCDFImapping(1B),respectively.Theinterrogatedepthwas15cmunlessotherwiseindicated.7/8/202631LLCHENMDPhDFACC准确测量PDA大小Figure2.2DEdidnotcompletelyrevealtheductmorphologyinapatientwithasmallPDA(2A);whileCDFIclearlydetectedaductshuntingjetenteringthepulmonaryarteryfromthedescendingaorta,producingavena-contractaphenomenon(2B),andthejetwidthof2.3mmwasmeasuredatthepoint(arrow)ofthevena-contractainthiscase,whichwasanalternativetodirect2DEmeasurement7/8/202632LLCHENMDPhDFACC准确测量PDA大小及合适选择封堵器ThemeasurementsofSDDandMDDin60patientswithafirstorasecondsuccessfulocclusionwere7.1±2.7mm(3.5-17.2mm)and5.4±1.4mm(3.1-10.3mm),respectively(P

0.001).Andtherewashighlylinearrelationship(SDD=1.67MDD-2.02,r=0.95,SEE=0.58,P

0.01)betweenSDDandMDD

7/8/202633LLCHENMDPhDFACC封堵器定位、形态判断、占位效应Figure3.Duringtheprocedure,whentheretentiondiskwasdeployed,2DEcouldclearlyrevealedtheextendeddiskagainsttheductampulla(3A);andfurtherwithdrawthedeliverysheathwasindicatedtodeploytheconicalsegmentofthedevice(3B);aproperlypositioningoccluderusuallyshowedanI-shapedappearancewiththeretentiondiskcloselyagainsttheampulla(3C);therewerenotanyADOprotrusionintotheleftpulmonaryartery(3D)7/8/202634LLCHENMDPhDFACC封堵器定位、形态判断、占位效应7/8/202635LLCHENMDPhDFACC残余分流观察、更换封堵器Figure5.Ontheleftpanel,CDFIdetectedasmallmarginalresidualshuntwithawidthof0.9mmimmediatelyafterwell-positionofanADO(5A),andCDFIcontinuousmonitoringrevealedtheshuntbecomesmallerat10min(5C)andfinallyvanishedat20min(5E).Conversely,ontherightpanel,CDFIdetectedalargemarginalresidualshuntwithawidthof2.1mmimmediatelyafterwell-positionofanADO(5B),andCDFIcontinuousmonitoringrevealedtheshuntdidnotchangeat10min(5D)andat30min(5F).7/8/202636LLCHENMDPhDFACC7/8/202637LLCHENMDPhDFACC7/8/202638LLCHENMDPhDFACC7/8/202639LLCHENMDPhDFACC7/8/202640LLCHENMDPhDFACCS2

及早发现及有效规避并发症7/8/202641LLCHENMDPhDFACCASD封堵术并发症病例—右心气栓7/8/202642LLCHENMDPhDFACCDualASDoccluders7/8/202643LLCHENMDPhDFACCVSD封堵术并发症病例—三尖瓣腱索断裂7/8/202644LLCHENMDPhDFACCVSD封堵术并发症病例—三尖瓣腱索断裂7/8/202645LLCHENMDPhDFACC准确的封堵器定位、形态判断、占位效应7/8/202646LLCHENMDPhDFACC这是什么？急性肺栓塞7/8/202647LLCHENMDPhDFACC急性主动脉夹层累及RCA这是什么？7/8/202648LLCHENMDPhDFACCS3

全数字便携彩色多普勒超声诊断仪

Terasont30007/8/202649LLCHENMDPhDFACC7/8/202650LLCHENMDPhDFACC7/8/202651LLCHENMDPhDFACC7/8/202652LLCHENMDPhDFACCTerasont3000Terasont3000加强型15.1吋高亮度、高分辨率、真彩显示屏15.4吋高亮度、高分辨率、真彩显示屏Centrino（迅驰）配置、WindowsXP平台Duel-CoreCentrino（迅驰）配置、WindowsXP平台**全息数码成像技术软件全息数码成像技术软件专利技术数码多声束形成技术专利技术数码多声束形成技术高倍数字处理通道软件双倍高倍数字处理通道软件**全程动态均匀聚焦全程动态均匀聚焦组织特性成像软件组织特性成像软件超宽频扫描软件超宽频扫描软件实时三同步功能软件实时三同步功能软件B型、D型、M型及扫描软件B型、D型、M型及扫描软件全息解剖M型（取样线可作360度旋转取样）全息解剖M型（取样线可作360度旋转取样）彩色能量多普勒

、彩色方向性能量多普勒软件彩色能量多普勒

、彩色方向性能量多普勒软件PW/CW多普勒血流测量与分析PW/CW多普勒血流测量与分析组织多普勒（TDI）组织多普勒（TDI）组织谐波成像技术组织谐波成像技术无OMNI成像软件**,完整的StressEcho(选配)**更高帧频**注：主要不同点标记为“**”7/8/202653LLCHENMDPhDFACCTerasont3000Terasont3000加强型原始数据处理软件；原始数据图像动、静态电影存储/回放软件原始数据处理软件；原始数据图像动、静态电影存储/回放软件伪彩软件(B

Color

Palette)

伪彩软件(B

Color

Palette)

各专科测量、计算、分析软件各专科测量、计算、分析软件原始数据动、静态图像存储/回放及处