先天性心臟病封堵治療基礎超聲影像課件

1、先天性心臟病封堵治療基礎超聲影像福建醫(yī)科大學附屬協(xié)和醫(yī)院心內科福建省冠心病研究所陳良龍 MD PhD FACCUUFighting CVD10/4/20221LL CHEN MD PhD FACC先天性心臟病封堵治療基礎超聲影像福建醫(yī)科大學附屬協(xié)和醫(yī)院心導管室彩色多普勒超聲的作用術前診斷/術中監(jiān)測/術后評價介入治療引導監(jiān)測先天性心臟病封堵治療瓣膜性心臟病擴張成形肥厚型心肌病消融治療擴張型心肌病同步治療急診胸痛病因鑒別急性冠脈綜合征主動脈夾層血腫急性肺動脈栓塞重癥心肌心包炎嚴重張力性氣胸導管并發(fā)癥早發(fā)現(xiàn)心包填塞心臟破裂接觸血栓腔內氣栓術后療效評價優(yōu)化影像形態(tài)學評估血流動力學評估器械是否需更換術式

2、是否需改變術后治療關注點10/4/20222LL CHEN MD PhD FACC導管室彩色多普勒超聲的作用術前診斷/術中監(jiān)測/術后評價介入S1 術中引導監(jiān)測10/4/20223LL CHEN MD PhD FACCS1 術中引導監(jiān)測10/2/20223LL CHEN MD1.導管房間隔缺損封堵術10/4/20224LL CHEN MD PhD FACC1.導管房間隔缺損封堵術10/2/20224LL CHEN 術前 ASD超聲評估ASD位置/形態(tài)/數(shù)目選擇合適ADO10/4/20225LL CHEN MD PhD FACC術前 ASD超聲評估ASD位置/形態(tài)/數(shù)目10/2/202心尖四腔觀房

3、間隔全長最大ADO缺損直徑解剖擴張缺損邊緣有無厚薄周圍結構PVCSSVCIVCMVTVAB10/4/20226LL CHEN MD PhD FACC心尖四腔觀房間隔全長AB10/2/20226LL CHEN 劍下四腔觀AB房間隔全長最大ADO缺損直徑解剖擴張缺損邊緣有無厚薄周圍結構PVCSSVCIVCMVTV10/4/20227LL CHEN MD PhD FACC劍下四腔觀AB房間隔全長10/2/20227LL CHEN 心底短軸觀主動脈對側房缺邊緣長度主動脈側房缺邊緣長度周圍結構主動脈根部SVCMVAB10/4/20228LL CHEN MD PhD FACC心底短軸觀主動脈對側房缺邊緣長

4、度AB10/2/20228LL劍下下腔觀AB房間隔缺損在IVC側邊緣殘端有無厚薄IVC側邊緣無殘端容易導致封堵失敗10/4/20229LL CHEN MD PhD FACC劍下下腔觀AB房間隔缺損在IVC側邊緣殘端10/2/2022術中 封堵器能否釋放夾住房間隔殘端的超聲影像觀察排除封堵器占位的超聲影像觀察10/4/202210LL CHEN MD PhD FACC術中 封堵器能否釋放夾住房間隔殘端的超聲影像觀察10/2/心尖四腔觀:通過牽/拉輸送系統(tǒng)確定房間隔前下/后上是否被封堵器夾住確定封堵器是否正常、移位。AB10/4/202211LL CHEN MD PhD FACC心尖四腔觀:通過牽

5、/拉輸送系統(tǒng)確定房間隔前下/后上是否被封堵劍下四腔觀:通過牽/拉輸送系統(tǒng)AB確定房間隔前下/后上是否被封堵器夾住確定封堵器是否移位10/4/202212LL CHEN MD PhD FACC劍下四腔觀:通過牽/拉輸送系統(tǒng)AB確定房間隔前下/后上是否被心底短軸觀:通過牽/拉輸送系統(tǒng)AB確定封堵器是否夾住主動脈側房缺殘端或抱住主A根部確定封堵器是否夾住主動脈對側房缺殘端10/4/202213LL CHEN MD PhD FACC心底短軸觀:通過牽/拉輸送系統(tǒng)AB確定封堵器是否夾住主動脈側各切面觀:排除封堵器占位二三尖瓣肺靜脈冠狀竇上下腔靜脈AB10/4/202214LL CHEN MD PhD F

6、ACC各切面觀:排除封堵器占位二三尖瓣AB10/2/202214L封堵效果好的超聲影像觀察術后 ASD封堵效果觀察10/4/202215LL CHEN MD PhD FACC封堵效果好的超聲影像觀察術后 ASD封堵效果觀察10/2/心尖四腔及大動脈短軸觀補片位置和形態(tài)良好對二、三尖瓣無影響對肺靜脈回流無影響良好環(huán)抱主動脈AB10/4/202216LL CHEN MD PhD FACC心尖四腔及大動脈短軸觀補片位置和形態(tài)良好AB10/2/2022.經(jīng)導管VSD封堵術10/4/202217LL CHEN MD PhD FACC2.經(jīng)導管VSD封堵術10/2/202217LL CHEN 術前 VSD

7、超聲評估VSD位置/形態(tài)/數(shù)目選擇合適ADO10/4/202218LL CHEN MD PhD FACC術前 VSD超聲評估VSD位置/形態(tài)/數(shù)目10/2/202室間隔缺損的形態(tài)分類 管狀 窗狀 囊袋型 漏斗型 10/4/202219LL CHEN MD PhD FACC室間隔缺損的形態(tài)分類 管狀 窗狀 囊袋型 漏斗型 10/2/心尖五(四)腔心切面室間隔缺損邊緣距主動脈瓣距離與瓣環(huán)的距離與竇的距離竇脫垂 室間隔缺損的形態(tài)長管狀短窗型漏斗狀囊袋狀：多漏口，基底寬室間隔缺損與三尖瓣的關系囊袋狀缺損與三尖瓣粘連三尖瓣粘連封閉缺損10/4/202220LL CHEN MD PhD FACC心尖五(四

8、)腔心切面室間隔缺損邊緣距主動脈瓣距離10/2/2左心室長軸切面室間隔缺損邊緣距主動脈瓣距離與瓣環(huán)的距離與竇的距離竇脫垂 室間隔缺損與三尖瓣的關系三尖瓣粘連封閉缺損囊袋狀缺損與三尖瓣粘連10/4/202221LL CHEN MD PhD FACC左心室長軸切面室間隔缺損邊緣距主動脈瓣距離10/2/2022心底短軸切面室間隔缺損的位置脊下型，膜部，膜周部脊內型，脊上型，干下型室間隔缺損的大小右室流出道情況10/4/202222LL CHEN MD PhD FACC心底短軸切面室間隔缺損的位置10/2/202222LL CH術中 VSD封堵超聲監(jiān)測封堵過程是否影響重要結構封堵效果及殘余分流10/4

9、/202223LL CHEN MD PhD FACC術中 VSD封堵超聲監(jiān)測封堵過程是否影響重要結構10/2/心尖五（四）腔心切面觀察輸送導管穿過室間隔觀察出鞘的封堵器是否影響二尖瓣腱索引起關閉不全10/4/202224LL CHEN MD PhD FACC心尖五（四）腔心切面觀察輸送導管穿過室間隔10/2/2022心尖五（四）腔心切面觀察封堵器位置是否正常觀察封堵器是否完全封堵缺損，是否有殘余分流10/4/202225LL CHEN MD PhD FACC心尖五（四）腔心切面觀察封堵器位置是否正常10/2/2022心尖五（四）腔心切面觀察封堵器是否引起主動脈瓣關閉不全是否觸及主動脈竇是否影響

10、主動脈瓣關閉觀察封堵器是否引起三尖瓣關閉不全三尖瓣腱索被夾，斷裂低血壓10/4/202226LL CHEN MD PhD FACC心尖五（四）腔心切面觀察封堵器是否引起主動脈瓣關閉不全10/左室長軸切面觀察封堵器是否引起主動脈瓣關閉不全，是否觸及主動脈竇或引起主動脈竇變形10/4/202227LL CHEN MD PhD FACC左室長軸切面觀察封堵器是否引起主動脈瓣關閉不全，是否觸及主動封堵效果與并發(fā)癥術后 VSD封堵效果觀察10/4/202228LL CHEN MD PhD FACC封堵效果與并發(fā)癥術后 VSD封堵效果觀察10/2/2022成功封堵封堵器位置良好無主動脈瓣返流無三尖瓣返流無

11、主動脈竇變形可釋放封堵器10/4/202229LL CHEN MD PhD FACC成功封堵封堵器位置良好可釋放封堵器10/2/202229LL3.超聲引導PDA封堵術10/4/202230LL CHEN MD PhD FACC3.超聲引導PDA封堵術10/2/202230LL CHEN測量PDA大小、觀察其形態(tài)、選擇封堵器Figure 1. The ampulla and the duct connection between the descending aorta and the left pulmonary artery in a patient with a megaphone-li

12、ke PDA were clearly visualized on the parasternal short axis view, and MDD of 4.3 mm and 4.5 mm was accurately measured in 2DEimage (1A) and CDFI mapping(1B),respectively. The interrogate depth was 15 cm unless otherwise indicated. 10/4/202231LL CHEN MD PhD FACC測量PDA大小、觀察其形態(tài)、選擇封堵器Figure 1. 準確測量PDA大小

13、Figure 2. 2DE did not completely reveal the duct morphology in a patient with a small PDA (2A); while CDFI clearly detected a duct shunting jet entering the pulmonary artery from the descending aorta, producing a vena-contracta phenomenon (2B), and the jet width of 2.3 mm was measured at the point (

14、arrow) of the vena-contracta in this case, which was an alternative to direct 2DE measurement 10/4/202232LL CHEN MD PhD FACC準確測量PDA大小Figure 2. 2DE did no準確測量PDA大小及合適選擇封堵器The measurements of SDD and MDD in 60 patients with a first or a second successful occlusion were 7.12.7mm (3.5-17.2mm) and 5.41.4

15、mm (3.1-10.3mm), respectively (P0.001). And there was highly linear relationship (SDD = 1.67 MDD-2.02, r=0.95, SEE=0.58, P0.01) between SDD and MDD 10/4/202233LL CHEN MD PhD FACC準確測量PDA大小及合適選擇封堵器The measureme封堵器定位、形態(tài)判斷、占位效應Figure 3. During the procedure, when the retention disk was deployed, 2DE cou

16、ld clearly revealed the extended disk against the duct ampulla (3A); and further withdraw the delivery sheath was indicated to deploy the conical segment of the device (3B); a properly positioning occluder usually showed an I-shaped appearance with the retention disk closely against the ampulla (3C)

17、 ; there were not any ADO protrusion into the left pulmonary artery(3D) 10/4/202234LL CHEN MD PhD FACC封堵器定位、形態(tài)判斷、占位效應Figure 3. Duri封堵器定位、形態(tài)判斷、占位效應Figure 4 On a modified super-sternal long axis view of the aorta arch with the probe tilted leftward, a well-positioning ADO (arrow) was clearly seen with

18、 mild occupation of the left pulmonary artery in 2DE image (4A), and CDFI demonstrated local flow turbulence (4B), indicating ADO-produced mild stenosis of the left pulmonary artery. On a super-sternal long axis view of the aorta arch, an ADO (arrow) was clearly seen with moderate occupation of the

19、descending aorta in 2DE image (4C), and CDFI demonstrated local flow turbulence (4D), indicating ADO-produced moderate stenosis of the descending aorta. The interrogate depth was 9 cm in figure 4C, 4D. 10/4/202235LL CHEN MD PhD FACC封堵器定位、形態(tài)判斷、占位效應Figure 4 On a 殘余分流觀察、更換封堵器Figure 5. On the left panel

20、, CDFI detected a small marginal residual shunt with a width of 0.9 mm immediately after well-position of an ADO (5A), and CDFI continuous monitoring revealed the shunt become smaller at 10 min (5C) and finally vanished at 20 min (5E). Conversely, on the right panel, CDFI detected a large marginal r

21、esidual shunt with a width of 2.1 mm immediately after well-position of an ADO (5B), and CDFI continuous monitoring revealed the shunt did not change at 10 min (5D) and at 30 min (5F). 10/4/202236LL CHEN MD PhD FACC殘余分流觀察、更換封堵器Figure 5. On the 10/4/202237LL CHEN MD PhD FACC10/2/202237LL CHEN MD PhD

22、FAC10/4/202238LL CHEN MD PhD FACC10/2/202238LL CHEN MD PhD FAC10/4/202239LL CHEN MD PhD FACC10/2/202239LL CHEN MD PhD FAC10/4/202240LL CHEN MD PhD FACC10/2/202240LL CHEN MD PhD FACS2 及早發(fā)現(xiàn)及有效規(guī)避并發(fā)癥10/4/202241LL CHEN MD PhD FACCS2 及早發(fā)現(xiàn)及有效規(guī)避并發(fā)癥10/2/202241LL CASD封堵術并發(fā)癥病例右心氣栓10/4/202242LL CHEN MD PhD FACC

23、ASD封堵術并發(fā)癥病例右心氣栓10/2/202242LL Dual ASD occluders10/4/202243LL CHEN MD PhD FACCDual ASD occluders10/2/202243LVSD封堵術并發(fā)癥病例三尖瓣腱索斷裂10/4/202244LL CHEN MD PhD FACCVSD封堵術并發(fā)癥病例三尖瓣腱索斷裂10/2/202244VSD封堵術并發(fā)癥病例三尖瓣腱索斷裂10/4/202245LL CHEN MD PhD FACCVSD封堵術并發(fā)癥病例三尖瓣腱索斷裂10/2/202245準確的封堵器定位、形態(tài)判斷、占位效應Figure 4 On a modifie

24、d super-sternal long axis view of the aorta arch with the probe tilted leftward, a well-positioning ADO (arrow) was clearly seen with mild occupation of the left pulmonary artery in 2DE image (4A), and CDFI demonstrated local flow turbulence (4B), indicating ADO-produced mild stenosis of the left pu

25、lmonary artery. On a super-sternal long axis view of the aorta arch, an ADO (arrow) was clearly seen with moderate occupation of the descending aorta in 2DE image (4C), and CDFI demonstrated local flow turbulence (4D), indicating ADO-produced moderate stenosis of the descending aorta. The interrogat

26、e depth was 9 cm in figure 4C, 4D. 10/4/202246LL CHEN MD PhD FACC準確的封堵器定位、形態(tài)判斷、占位效應Figure 4 On這是什么？急性肺栓塞10/4/202247LL CHEN MD PhD FACC這是什么？急性肺栓塞10/2/202247LL CHEN 急性主動脈夾層累及RCA這是什么？10/4/202248LL CHEN MD PhD FACC急性主動脈夾層累及RCA這是什么？10/2/202248LLS3 全數(shù)字便攜彩色多普勒超聲診斷儀Terason t300010/4/202249LL CHEN MD PhD FAC

27、CS3 全數(shù)字便攜彩色多普勒超聲診斷儀Terason t3010/4/202250LL CHEN MD PhD FACC10/2/202250LL CHEN MD PhD FAC10/4/202251LL CHEN MD PhD FACC10/2/202251LL CHEN MD PhD FAC10/4/202252LL CHEN MD PhD FACC10/2/202252LL CHEN MD PhD FACTerason t3000Terason t3000加強型15.1吋高亮度、高分辨率、真彩顯示屏 15.4吋高亮度、高分辨率、真彩顯示屏Centrino（迅馳）配置、WindowsXP平

28、臺 Duel-Core Centrino（迅馳）配置、WindowsXP平臺*全息數(shù)碼成像技術軟件 全息數(shù)碼成像技術軟件專利技術數(shù)碼多聲束形成技術 專利技術數(shù)碼多聲束形成技術高倍數(shù)字處理通道軟件 雙倍高倍數(shù)字處理通道軟件*全程動態(tài)均勻聚焦 全程動態(tài)均勻聚焦組織特性成像軟件 組織特性成像軟件超寬頻掃描軟件 超寬頻掃描軟件實時三同步功能軟件 實時三同步功能軟件B型、D型、M型及掃描軟件 B型、D型、M型及掃描軟件全息解剖M型（取樣線可作360度旋轉取樣） 全息解剖M型（取樣線可作360度旋轉取樣）彩色能量多普勒、彩色方向性能量多普勒軟件 彩色能量多普勒、彩色方向性能量多普勒軟件PW/CW多普勒血流測量與分析 PW/CW多普勒血流測量與分析組織多普勒（TDI） 組織多普勒（TDI）組織諧波成像技術 組