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1、先心病介入治疗解剖基础方臻飞意义o先心病介入治疗的基础o有助于更好的超声诊断o有助于CTA、MRA及DSA影像诊断o指导适应症的筛选和并发症的防治相关学科o组织胚胎学o解剖学o超声诊断o影像诊断o心外科o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: 332-343Anderson的VSD分类VSD分型VSD分型nVentricular septal defects:how
2、 shall we describe,name and classify them? Van Praagh R,Geva T,kreutzer J. J Am Coll Cardiol 1989,14:1298-1299Van Praagh的VSD分类VSD分型v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普勒超声v膜周部VSD周
3、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 representation viewing the oval fossa
4、 from the right atrial aspect. The oval fossa flap valve and the immediate rim is the true extent of the atrial septumDiagrammatic representation of the heart in 4-chamber section.The flap valve overlaps the superiorly infolded walls of the atriums, partitioning the two chambersClose-up four chamber
5、 view of the RA and RV, showing the muscular superior and inferior rims, and the flap valve of the oval fossa dividing the two atriumsA: Anterior view of the right atrium, showing the relationship of the aortic mound (red square) to the oval fossa. B: A needle passing through the aortic mound (red s
6、quare) would exit the heart into the transverse sinusFour 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 sinus node and arteryRight atrial view s
7、howing the oval fossa (black dots) surrounded by septal marginsRight 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 for closure of a secundum atrial septal defe
8、ctShows 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 deviceThis inferiorly located atrial septal defect is near the entrance of the ICV into the right atrium下腔型房间隔缺损A
9、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 heart, the oval fossa is fine and shows extensive fene
10、strations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, giving rise to various degrees of fenestrations. In this
11、 case two separate holes have formed, making interventional closure a more difficult procedureA) The atrial septum in the normal heart. The interatrial infolding is filled with extracardiac fibro-fatty tissue (yellow). B) In hearts with a superior sinus venosus defect the defect is superior to the o
12、val fossa. Extracardiac fibrofatty tissue (yellow) incorporated into the superior rim of the septumThe defect overrides the superior rim of the oval fossa, resulting in the SCV having direct communication to both the right and left atriums. Note the anomalous connection of the pulmonary vein to the
13、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ASDPosterior view of the heart showing a coronary sinus defect, where parts of the wall are absent allowing discrete communication into t
14、he left atrium冠状静脉窦型ASDA) 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. Instead the coronary sinus opens directly from the right atrium i
15、nto the left atrium. Probe in persistent left superior caval vein (LSCV )冠状静脉窦型ASDAn ostium primum atrioventricular defect viewed from the base of the heart into the ventricular mass. It comprises a common atrioventricular junction, with separate valvar orifices to each ventricle, and an anteriorly
16、displaced aorta原发孔型ASDLong axis view of a heart with an ostium primum defect. The defect permits communication at atrial level原发孔型ASDLong 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 left AV valve to the crest of the ventricular septum creates a separate orifice to each ventri
