先心病介入治疗解剖.ppt

1、先心病介入治疗解剖基础,方臻飞,意义,先心病介入治疗的基础 有助于更好的超声诊断 有助于CTA、MRA及DSA影像诊断 指导适应症的筛选和并发症的防治,相关学科,组织胚胎学 解剖学 超声诊断 影像诊断 心外科 先心病介入治疗,室间隔缺损,Classification of ventricular septal defects B Soto, AE Becker, AJ Moulaert, JT Lie, and RH Anderson.Br. Heart J. 1980; 43: 332-343,Anderson的VSD分类,VSD分型,VSD分型,Ventricular septal def

2、ects:how shall we describe,name and classify them? Van Praagh R,Geva T,kreutzer J. J Am Coll Cardiol 1989,14:1298-1299,Van Praagh的VSD分类,VSD分型,膜部室间隔,心脏病理标本房室隔右面观（左心室侧置强光源），三尖瓣隔瓣与室上嵴交界处透亮部分为膜部室间隔，三尖瓣隔瓣附着线（蓝色）横跨与膜部之上。,膜周流入道VSD,病理：房室间隔右室面观,超声：胸骨旁五腔切面,膜周流出道VSD,病理：室间隔右室面观,超声：左室长轴切面,膜周小梁部VSD,超声：胸骨旁五腔切面,彩色多

3、普勒超声,膜周部VSD周缘因三尖瓣遮挡，可有火山口样纤维增生， 称之假性室隔瘤形成，缺损有逐渐减小或自愈的趋势,二维超声：心尖四腔切面,实时三维超声心动图,肌部VSD 最常见部位在室间隔中部，即调节束起源处 次常见部位在隔缘束的上下肢分叉处 心尖部是另外一种常见类型,肌部VSD,病理：室间隔左室面观,超声：心尖四腔切面,肌部VSD,病理：室间隔右室面观,超声：胸骨旁五腔切面,病理：室间隔右室面观,肺动脉瓣下VSD：主动脉瓣易脱垂嵌入缺损,超声：左室长轴切面,病理：室间隔右室面观,双动脉下VSD,超声：左室长轴切面,房间隔缺损,房间隔的胚胎发育,房间隔缺损的分型,Diagrammatic rep

4、resentation viewing the oval fossa from the right atrial aspect. The oval fossa flap valve and the immediate rim is the true extent of the atrial septum,Diagrammatic representation of the heart in 4-chamber section.The flap valve overlaps the superiorly infolded walls of the atriums, partitioning th

5、e two chambers,Close-up four chamber view of the RA and RV, showing the muscular superior and inferior rims, and the flap valve of the oval fossa dividing the two atriums,A: Anterior view of the right atrium, showing the relationship of the aortic mound (red square) to the oval fossa. B: A needle pa

6、ssing through the aortic mound (red square) would exit the heart into the transverse sinus,Four chamber view showing the infolded right atrial wall, Waterstons groove, which is filled with extracardiac fat.,Anterior view showing the junction between the RAA and the SCV, this is the location of the s

7、inus node and artery,Right atrial view showing the oval fossa (black dots) surrounded by septal margins,Right atrial view showing flap valve tissue that fails to fully cover the margins of the oval fossa,卵圆孔未闭,Right atrial view showing complete absence of the flap valve tissue,继发孔房间隔缺损,An ideal case

8、 for closure of a secundum atrial septal defect,Shows the proximity of the superior caval vein, the coronary sinus in the right atrium and the right pulmonary vein in the left atrium to the area which is covered by an atrial septal device,This inferiorly located atrial septal defect is near the entr

9、ance of the ICV into the right atrium,下腔型房间隔缺损,A device placed to close this defect may occlude the SCV venous return, due to a narrowed superior rim (green square),上腔型房间隔缺损,View of the right atrium showing fenestrations within the flap valve of the oval fossa,筛孔型房间隔缺损,Right atrial view in another h

10、eart, the oval fossa is fine and shows extensive fenestrations,筛孔型ASD并房间隔瘤,Seen from the left atrial aspect the flap valve of the oval fossa is highly fenestrated, and the extensive tissue is prolapsing into the left atrium,筛孔型ASD并房间隔瘤,A spectrum of deficiencies can affect the oval fossa flap valve,

11、 giving rise to various degrees of fenestrations. In this case two separate holes have formed, making interventional closure a more difficult procedure,A) The atrial septum in the normal heart. The interatrial infolding is filled with extracardiac fibro-fatty tissue (yellow). B) In hearts with a sup

12、erior sinus venosus defect the defect is superior to the oval fossa. Extracardiac fibrofatty tissue (yellow) incorporated into the superior rim of the septum,The defect overrides the superior rim of the oval fossa, resulting in the SCV having direct communication to both the right and left atriums.

13、Note the anomalous connection of the pulmonary vein to the SCV,上腔型ASD并PV异位引流,View of the left atrium showing a fenestration between the coronary sinus, which has its own muscular wall, and the cavity of the left atrium,冠状静脉窦型ASD,Posterior view of the heart showing a coronary sinus defect, where part

14、s of the wall are absent allowing discrete communication into the left atrium,冠状静脉窦型ASD,A) Right atrial view displays an enlarged orifice to the coronary sinus. (Probe in SCV) B) Left atrial view of same heart, there is no coronary sinus channel running within the posterior wall of the left atrium.

15、Instead the coronary sinus opens directly from the right atrium into the left atrium. Probe in persistent left superior caval vein (LSCV ),冠状静脉窦型ASD,An ostium primum atrioventricular defect viewed from the base of the heart into the ventricular mass. It comprises a common atrioventricular junction,

16、with separate valvar orifices to each ventricle, and an anteriorly displaced aorta,原发孔型ASD,Long axis view of a heart with an ostium primum defect. The defect permits communication at atrial level,原发孔型ASD,Long axis view of a heart with ostium primum defect. The inferior margin of the atrial septum does not connect with the ventricular mass, forming a common atrioventricular junction. Attachment of the