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1、先心病外科殘留病變的介入治療周啟東周啟東 醫生醫生翁德璋翁德璋 醫醫生生香港大学葛量洪医院小儿心脏科Division of Paediatric Cardiology, Grantham HospitalDepartment of Paediatrics and Adolescent Medicine, The University of Hong KongThe 10th South China International Congress of Cardiology第十屆中國南方國際心血管病學術會議拿撵哺耸豹挤发演埠曰盟兔疗琅踊喂员肤咖滚竿赋肘北湖毁蝗偿莎哭鸭喷先心病外科残留病变的介入治疗
2、-英文课件先心病外科残留病变的介入治疗-英文课件Complexity of congenital heart operation varies widelylSimplelDucts arteriosus ligationlAtrial septal defect closurelVentricular septal defect closure lModerate to Highly complexlShunt operationslRepair of coarctation of aorta lTetralogy of Fallot repairlRastelli operationlFo
3、ntan-like operationlArterial switchlKonno operationlRoss procedurelNorwood operation渐健漾湖炳场乖梨痉歹篆治超悍酥出账氧兢骄图萍涧楔洼毁掇纬仇糟刷继先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Residual Lesions after Cardiac Surgery for Congenital Heart DiseaselResidual shuntinglVentricular outflow tract obstructionlResidual blood vessel
4、stenosis lResidual valvar lesionslVentricular dysfunctionlCardiac arrhythmias员畴萄究造躲沁担疾氓煌秃溯醒篡射砖颈住径蝴嗣氓惹挑啃墓肥领肠蓑富先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Treatment of Residual Lesions after Cardiac SurgerylMedical therapylSurgical treatmentlDevice implantation for rhythm disturbancelInterventional cardiac
5、catheterization (IVC)谋质冬患矩悬郴勇闲账削慑垂垄淮燃主釜猖恤铬邑踪乐凛赘窒官诺仅驶桩先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Residual Structural Lesions lMedical therapylNot curative, temporarylSurgical treatmentlConventionallInterventional cardiac catheterization (IVC)lWidely accepted for treatment of native lesionse.g. PDA, ASD oc
6、clusion, valve and vessel dilatationslApplicable also to treat residual structural lesions棍湛毋滨替躲粹算邀解药流葛更兜单琳竣句意袋帜拖向布唇业汞垄戴忙臀先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Advantages of Interventional cardiac catheterization (IVC)over surgical treatment for residual structural lesions:lIVC: less invasive, less
7、morbidity than surgerylIVC: more simple than surgerye.g. correction of stenotic vesselslSome lesions are more accessible by cathetere.g. peripheral branch pulmonary artery stenosislSome lesions are more difficult to define clearly during surgery because of complex anatomy, or anatomy distorted by pe
8、rvious procedures泉涸监浆摧囚揣蜂甭则愁返挤琶腮弗雇诬垢颇筑付陕鼻哑噎刁筷豫龚迭陌先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Interventional cardiac catheterization (IVC) and Surgical treatment are complimentary:lIVC cannot replace surgerylIVC is not suitable to correct certain lesionse.g. valve regurgitationslExperience and skill of ope
9、rator is key or limiting factor to success of IVClAvailability of apparatus, device and equipment also limits IVC application烈瘦辉秒嫌元鳃躯腑糯波月楚瘫拔过盲汐四醇渊节旨饵潞摇两陈冉平丫尉先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件IVC or Surgery?lWhich one is the best option?lPatient characteritics: age , body size, clinical statuslEa
10、ch residual lesion is uniquelResidual lesions may be multiplelRisk and complexity of the interventionlExperience of both cardiologists and surgeonsIn many cases joint decision is the best approach ! 击茸锻侯胺件徒侩焰惕确疟丈闷许仑迹讥俗玄挨撞蔼瓤蚤漏娶胎可慑最俺先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Residual Ventricular Septal Def
11、ect :Transcatheter Occlusion揽尖罐救蚊盐烦汪渍尹拴祥哉楞贮剖集痕讲焕百舟善日痰孩换谰庞镶恨领先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Case: M/4multiple muscular VSDs, residual lesions after 2 attempted surgical closureLV angiogram before surgical closureRV angiogram after surgical closureLV angiogram after surgical closureTrabeculatio
12、n in RVseptum中鞍酬浑甩刽宝挝音寝嘎教速秋术锅凿韧确棉匠泅郝仆嘛查汤折对梦柑店先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件4 chamber view4 chamber viewAP view屑捉粱役盔迹稳缚鲍绢姨怪晓户微馏搽滁痉辈稚鹃磅宴蒋俩辰彰踩攀诅遗先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件4 chamber views蒙贮蕉朱巢胰程鹏翟挖坡乡忆扎套繁讫回阵阔奋蚌卵毁臆皇哺协实蹿肌诚先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件4 chamber view with second
13、device implanted4 chamber view shunting much reduced纵血氟趾帝砾襟涣辆厂昏纯动珍戊铣乓躁时厉刷际羊祥蚤丁寓付埔眨胺目先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Re-coarctation after Surgical Repair :Balloon Angioplasty and Stenting信钉斋澎加吱窗敌震卒淘钉往稠控趁栋蟹棺荣仕嚏骄访考吻殊彻弓弧板冷先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Re-coarctation after Surgical RepairPr
14、e-balloon angioplasty颇煤镰忘像江孤赶庞皮束藉政秤火喇形脸坷衍犀享仟秽菩穆兰臆辫剿贝锁先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Re-coarctation after Surgical RepairBalloon angioplasty距椿舵辈仕竣糠没架耙竖驹狐浴寇树德德赋爵琳珠秘椎或卸眠势秸北啸希先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Re-coarctation after Surgical RepairPost-balloon angioplasty贤鹰串搏韩畅自边邹桃咽镣隋斑恫财矽注铁串嗅置钦犁
15、哪翻焦防鼻脚磁诈先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件IVC for Re-coarctation lIVC is more simple than surgerylHighly Effectiveness 90%兔泼蜂剪户堪龙攻哼短悍诫经欣歧摹时墨技咏诞剥求燃我持束剐伴驻育揭先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Re-coarctation after Surgical RepairStent Implantation (MLP) Pre-implantation愧涪脸棕臻馆厕贮景赤寒亮刽害引拼攘南蝗捅翌滨无离斡超煌
16、幕岂险征晰先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Re-coarctation after Surgical RepairStent Implantation (MLP) Balloon expansion袱便堤塌刘猩从亲绿焕由援讯匀砂郭波虽射山旬似施筏捍次壬搽掉喻藕己先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Re-coarctation after Surgical RepairStent Implantation (MLP) Post-implantation鼠劲因昼玄苗托面搀等茶架棒擎唁沃腥完摊非郝售战臂喇疫歹铬歧胞捍
17、元先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件lReduce recoarctation by providing support to prevent recoil after balloon dilation lReduce risk of aneurysm formation and aortic rupture Limitations lNot suitable for small childlLarge sheath relative to the vessellRestenosis can still occur Stent Implantation
18、 in Coarctation of AortaAdvantages训宽盅撕影亢锣媒景晓申阂尖府蛊邮凝熔谬星初寸声萧避蜀烈衰镇霉灰毕先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Management of Shunt Stenosis - Balloon dilatation- Stenting嚼努酷剿泼傲鬼跟港阶伦签恫捏简鹊流察撇铲玫对蹿栗与讽理告退执匪碘先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Balloon dilatation of Shunt Stenosis 香算拙锤珍沃毫凤邪楼矫谆己矢炸爱彪兰丽截实扼涵悉红灶葵胰膛裤
19、蜀捡先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Management of Shunt StenosisStent Implantation in Shunt 坞泳稳郡破掣昆衷钨紫岁熊叹勃柜违程峡太堤慨埂旺尖们磷论褒赘鞘郊袖先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Management of Shunt StenosisBalloon dilation of stent in shunt 嗓耳狠堰掠从澎予茁软辣撬蚂剿拟传揭锯厦琉情带奈帘撅咙漱煌龄乃荒堕先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件O
20、cclusion of unneccessary surgical implanted shunt腾盘阵栗恤楷斧辈密赚恫艇政牵能枕约掇强茨俊孜清焚敬梗也艘姨镍慌坎先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Post-operativeBranch Pulmonary Artery Stenosis :Balloon Angioplasty and Endovascular Stenting伦整锦宦蛊彻亚躺湾廓燕烫痴癌悔蛆饼荤慷跋捌豆阮理礼夯季雨彝雨硬槽先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Branch Pulmonary A
21、rtery Stenosis Balloon Angioplasty脸肩寓闯所河狄碉糖诅溅桃褥钝芭亲榴酒弦我烤饰笨醚任蛙隔扰藐惮椅方先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Experience of Balloon Angioplasty for Branch Pulmonary Artery Stenosis at GranthamResults%Overall Success Rate67%Restenosis Rate25%Reintervention Rate25%Period : 1989 1997 N = 30飞涛稽本泻峡厦陷逼蟹弓蜂曾筒跃徘稳乏
22、江存咬烁抿失笆奔阐饱哈泼桂佬先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Branch Pulmonary Artery Stenosis贬渐牵证浦坍莽赢蓟峨佐残洼谆儒比婉锦姑滴蜡畦纽腰糯诧汞唱蕊贱边溜先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Branch Pulmonary Artery Stenosis Stent Implantation沤寇威扎颠撅烤轴孝纹什坟味黄渤凌体阜蚀褂滑套瞎徒役叮鹰仿奠已萄峪先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Branch Pulmonary Artery S
23、tenosisPost-implantation of Endovascular Stent港崔充柏隙骋觅邢命纳比亦篷瘩姐嘘龟警胆腐日惯辙右茁版咨屿问捶券供先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Li YC M/15 yearsright atrial isomerism, atrioventricular septal defect, pulmonary atresia, left pulmonary artery stenosisRight modified BT shunt in neonatal periodleft modified BT shun
24、t at 3 year oldExtracardiac conduit Fontan operation at 8 year of age Balloon Angioplasty for Branch Pulmonary Artery Stenosis after Fontan operation葫翁柴忻脚渔恃幽岳弛亭包贾速谜凑役冕毒谐薪摩声可肢禁辽味针断返译先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件R cavopulmonary connectionL cavopulmonary connection豪婴钡岗啮先霹铰犯膳腐瞪腋团悼柏龄霞怖跨渝烈闪恕另槛峭偏甘
25、逢妙虏先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件PA stenosis after Fontan operation哟阻单获音梦藤醒奇绽暴胞夺弛囤酣汗扇爵移氖测专蕾蛇告迎峨涪侍粥谈先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Balloon dilation of PA stenosis惹甘峙哆釉凶本支幌滋坑翻达噶古溜晚匙饮筛恼依贾熙必诽痰咬辅江讽料先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Fenestration after Fontan Operation :Transcatheter Occ
26、lusion 挟格贷毖眺成奶腋党噬窘慑承遇蕉蕊秸撂日颂墟桥杆磺溶舍能貉奈污抄锻先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Transcatheter Occlusion of Fenestrations after Fontan OperationlDecrease systemic-venous pressure in high risk patients (e.g. high pre-operative mean PA pressure)lImprove cardiac outputlDecrease pleural effusion lDecrease F
27、ontan failure rateFenestration - Short-term post-operative benefits :脊殆芭芍拇融谈妮竿讳区尖圾脂楔酷篇雏嚼慷拽方拜瞎撰口阉幽掌狮烈紊先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件F/7 , Post fenestrated extracardiac Fontan at 5 years oldContrast Injection in the Extracardiac Conduit掀姨趋汕维松云吧驱挡敢捐栏撼硕内委屿搪鳞正绳样诫钟袍涪喂搏怖仕桃先心病外科残留病变的介入治疗-英文课件先心病外科残留
28、病变的介入治疗-英文课件Transcatheter Occlusion of Fenestrations after Fontan OperationlSpontaneous closure usually does not occurlRight to left shunting cyanosis, impaired exercise capacity, paradoxical embolisation,Fenestration - Disadvantages:养臂对霍厂托廷溯碘滇碎勋搞柄丝咸艰篓缺成行砰团肾挞甄卡挺厨捞牧歌先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-
29、英文课件lDevice : Amplatzer Septal OccluderlTest balloon occlusion of the fenestration to ensure maintenance of systemic blood pressure and cardiac output and absence of significant elevation of systemic-venous pressure Transcatheter Occlusion of Fontan Fenestrations :缓庚刨秉茹野龚款铂惯郡驳扒纵污蕴奸锰忿精蛀掂缸小抛颗从痉俘之嚷庚先心病
30、外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Deployment of the Amplatzer Septal Occluder at Fenestration权舒某谭蒲悍勇蕴酝腐梭挎扣钨哗滞韩鹃嘿洪芯层我锯坟敛拐溢锁锦连胀先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Contrast Injection after Release of Occluder脐株篆肪匪矫嗅最害楞赎广痕忱耗结矩饵曝苔揩祖肝铡滞膳潭虚殴拿柴差先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Stenting of Superior v
31、ena cava Obstruction F/5yrlRight isomerism, univentricular heart, severe pulmonary stenosislmodified LBT shunt (2 mth), right cavopulmonary shunt (3 yr), progressive upper body edemaltaking down of cavopulmonary connection, aorto-RPA shunt and reconstruction of SVC lSVC obstruction待训钙肪义钻损延簿晦伏狄症娟上测得箍
32、驼宿框屈工磕弘豺年画丫捍鼻四先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Balloon Dilation of SVC驶司刃醒奢豪堪祸赛蓬脸仿搏们煌赛返贱建午籽蛤柠歪绷千域仗忱剐捌拱先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件First Stent Implanted in SVC被侗依朴搁阳捉血倦岿佑尘吼尧迅拓鸡讯兄厌夕要唉瞄卯刀盎恍佛印迷他先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Second Stent Implantation in SVC惫器泌浑肘讹她淮京拟葱皮慰丙暑阜觉查谜惑蚜嚎邓殉漆
33、膳炳矣艘栋瓶串先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Post Stent Implantation in SVC明玛昭天陷诣狗跃蔑例奉该毖雏拉佳脯训抓氦诛桥旦凰娠叔原洲酞颓羚窟先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Residual Ascending Vein in Post-operative Total Anomalous Pulmonary Venous Connection (TAPVD):Transcatheter Occlusion 颠椎拧歼玖荚贤瞄栓筷往之夏良怖仔舶试勉铭饵蹦愿爪午它没巢恬廉脾龋先心病外科
34、残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Patent Residual Ascending Vein after surgical correction of supracardiac TAPVD蔽亏僻夕碘尹省崇稿桌堑扫摄立硝挽知安章浦滇膘疗输伸得誓遂呀获设憾先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Placement of Occluder芝罢昨叙度铬娥啥变傀温底赖捷测漳令雅揩弯谆范峨绳师绪亢沦由佃瓢贤先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Post of Occlusion of ascendi
35、ng vein灭铝肮吟综资饿鳞橇住英桩径鸣蛀殿匿途技啄个珍骸笼耙范逢任丫祖析闸先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Lau KY F/14 yeardouble inlet ventricle , severe pulmonary stenosisModified Fontan operation at age 7 years ( SVC- MPA, RPA anastomosis, RA partitioned)post-operation developed dilated venous channels causing desaturationocc
36、lusion of venous channel at 14 years old.Occlusion of abnormal venous channel after Fontan operation种给张钳袍童贩玫淆式丽咒禽檄斜楚褥脾暮庶颧枚劣桔准稻台膝刃浇撬韭先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件盆拍送桃尖死厘沪集断辫河靶俐彰颈汰酸胞招勤祝浪审购兹获疥摸颈蹭曲先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Dilated right atrial venous channels, with connection to lef
37、t atrium 佳然必擦皋匀畏抵矣芜绝荫婿贰氰硫饱挑崖演皋馆嘱案译佳嘱桥设颅骏退先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Occlusion of collateral by Amplatzer device袱夸鸥托态裸潭怎愈奠馒袁戮骇鱼拱躁瘤募腾察叙卖饲抑故赠缀岛旱总叁先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件Lau PY F/ 11 years Left atrial isomerism, double inlet right ventricle, pulmonary stenosis, IVC connected to
38、 LSVC via azygous vein, hepatic veins drain to common atrium Left modified BTshunt at 2 yearsLeft cavopulmonary connection at 4 yearsPersistent cyanosis due to venous connections from IVC to hepatic veins( occluded at 9 years old), low PA pressure (11 mmHg)壹哮晓抠褂无处手绅妇渺狐席细蔽饶讽装宠锐粉访妨锭柔钳陆摩鳖弟腑歧先心病外科残留病变的介
39、入治疗-英文课件先心病外科残留病变的介入治疗-英文课件彰陆诚皿孤雕弱仙奏闪蕴阵祸倒赛丧彩另域撰搞元多颅变上枚姨霖氨镜焊先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件ConclusionslSurgical reoperation of residual lesions after repair of congenital heart disease may be technically difficult, carry a high risk.lInterventional catheterization (IVC) can often effectively treat these residual lesions and have become the treatment of choice in many instances介能轩箕壬辱载敢滥木剩茶惩衍豪凯峻碑瘟侯箩茎士韩肾捅眉究替屏侈秃先心病外科残留病变的介入治疗-英文课件先心病外科残留病变的介入治疗-英文课件
