心脏外科学讲义英文版.ppt

1、Heart Surgery,WuChangXue Dept of thoracic cardiovasclar surgery,LZMC,PA blood increase,Blood shut from left heart system to right at atrial, ventricular or great artery level PDA ASD VSD AV canal defect,PDA-Patent ductus ateriosus,role of ductus arteriosus Location Recurrent laryngeal nerve Fail to

2、close after 3 months,Funnel,Physiology of PDA,Diagnosis of PDA,Body sign: continous machinery murmur SBP-DBP increase LV enlarge Electric cardiography Echocardiography X-ray Cardiac catheterization,Treatment of PDA,Complication of PDA ligation,Bleeding Recurrent laryngeal nerve injury Aneurism Reope

3、n Reflective high blood pressure other,ASD,Premum partial atrial ventricular canal defect Secundem ostium SVC IVC mixed CS,Pathophysiology of ASD,L-R shunting Pulmonary hypertension P vascular dis Eisenmenger syndrome,Disgnosis of ASD,Physical exam: SM, P2 Subtle sign of heart failure: exercise ,pal

4、pitation,arrhythmias Echo CG Electric CG catheterization,treatment,PFO:80% spontaneous closure in 1st. closure for :symppomatic patients significant ASD L-R shunt over 1.5:1 Closure way: surg percutaneous transcatheter device transthoracic catheter device transthoracic scope assisted,VSD,Perimembran

5、ous Muscular Subarterial Atrioventricular,Pathophysiology of VSD,L-R shunting P blood increase LV volume overload PH Eisenmenger syndrome,Disgnosis of VSD,Physical exam: SM, P2 Subtle sign of heart failure: exercise intolerance,palpitation, arrhythmias Echo CG Electric CG catheterization,Treatment,S

6、pontanous clsoure closure for :symppomatic patients large VSD Closure way: surg percutaneous transcatheter device transthoracic catheter device transthoracic scope assisted,Surg for VSD,Heart incision Patch Complication,TOF,VSD Aortic overiding RVOTO RV hypertrophy combined abnormalities,Disgnosis o

7、f TOF,Clinical: symptoms( cyanosis, anoxia spell, exercise intolerance, squat ) body sign( dysplasia, cyanosis, pestle loke finger , heart check) X-ray: boot shape Echo CG Electric CG catheterization,Rescue for TOF spell,Knee-to-chest Oxygen Sedation: morphine Volume expansion Increase cardiac prelo

8、ad and systemic resistance,Surgery for TOF,Two stage: classic and modified blalock-taussing shunt Single stage: VSD closure+ RVOTO relief,Valve Disease,Congenital Rheumatic Degenerative Infection Immune,Mitral valve stenosis,MS,Valvular lesions free edge echo intensity, thickening, valvular adhesion

9、, opening area is reduced： minor：1.52.0 cm2 moderate：1.01.5 cm2 severe：1.0 cm2,Ppv,Whole heart failure,MS,PGa-v,PH,RV ,LA ,RV failure,LV failure,Clinical Manifestations,Symptoms (1) Dyspnea: The earliest symptoms; (2) hemoptysis, bloody sputum; (3) cough; (4) hoarseness; (Signs (1) mitral valve face

10、. (2) signs of heart mitral stenosis; apex beat is not obvious; S1 loud; DM. (3) pulmonary hypertension and right ventricular dilatation,Echo,N,Ms,N,Ms,Aortic stenosis（AS）,Etiology Congenital: Congenital hypoplasia of the aortic valve, two lobes or multiple lobes; subvavular located stenosis; Acquired: rheumatic or senile degeneration,Pathology and hemodynamic changes,An aortic valve itself increased pressure load,AS,LVH,LHF,Increase in myocardial oxygen consumption,Intracardiac diastolic pressure,Coronary perfusion,Myocardial ischemia,Clinical Infestation,Symptoms: Dyspnea, angina, synco