先天性心臟病封堵治療基礎超聲影像

先天性心臟病封堵治療基礎超聲影像先天性心臟病封堵治療基礎超聲影像先天性心臟病封堵治療基礎超聲影像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是否需改變術后治療關注點11/17/20202LLCHENMDPhDFACC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是否需改變術后治療關注點2/2/20232LLCHENMDPhDFACCS1術中引導監(jiān)測2/2/20233LLCHENMDPhDFACC1.導管房間隔缺損封堵術2/2/20234LLCHENMDPhDFACC術前ASD超聲評估ASD位置/形態(tài)/數(shù)目選擇合適ADO2/2/20235LLCHENMDPhDFACC心尖四腔觀房間隔全長最大ADO缺損直徑解剖擴張缺損邊緣有無厚薄周圍結構PVCSSVC\IVCMV\TVAB2/2/20236LLCHENMDPhDFACC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PVCSSVC\IVCMV\TV2/2/20237LLCHENMDPhDFACC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SVCMVAB2/2/20238LLCHENMDPhDFACC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2/2/20239LLCHENMDPhDFACC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2/2/202310LLCHENMDPhDFACC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。AB2/2/202311LLCHENMDPhDFACC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2/2/202312LLCHENMDPhDFACC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2/2/202313LLCHENMDPhDFACC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AB2/2/202314LLCHENMDPhDFACC封堵效果好的超聲影像觀察術后ASD封堵效果觀察2/2/202315LLCHENMDPhDFACC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AB2/2/202316LLCHENMDPhDFACC2.經導管VSD封堵術2/2/202317LLCHENMDPhDFACC術前VSD超聲評估VSD位置/形態(tài)/數(shù)目選擇合適ADO2/2/202318LLCHENMDPhDFACC室間隔缺損的形態(tài)分類管狀窗狀囊袋型漏斗型2/2/202319LLCHENMDPhDFACC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2/2/202320LLCHENMDPhDFACC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2/2/202321LLCHENMDPhDFACC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2/2/202322LLCHENMDPhDFACC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2/2/202323LLCHENMDPhDFACC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2/2/202324LLCHENMDPhDFACC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2/2/202325LLCHENMDPhDFACC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2/2/202326LLCHENMDPhDFACC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2/2/202327LLCHENMDPhDFACC封堵效果與并發(fā)癥術后VSD封堵效果觀察2/2/202328LLCHENMDPhDFACC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主動脈竇變形可釋放封堵器2/2/202329LLCHENMDPhDFACC3.超聲引導PDA封堵術2/2/202330LLCHENMDPhDFACC測量PDA大小、觀察其形態(tài)、選擇封堵器Figure1.Theampullaandtheductconnectionbetweenthedescendingaortaandtheleftpulmonaryarteryinapatientwithamegaphone-likePDAwereclearlyvisualizedontheparasternalshortaxisview,andMDDof4.3mmand4.5mmwasaccuratelymeasuredin2DEimage(1A)andCDFImapping(1B),respectively.Theinterrogatedepthwas15cmunlessotherwiseindicated.2/2/202331LLCHENMDPhDFACC準確測量PDA大小Figure2.2DEdidnotcompletelyrevealtheductmorphologyinapatientwithasmallPDA(2A);whileCDFIclearlydetectedaductshuntingjetenteringthepulmonaryarteryfromthedescendingaorta,producingavena-contractaphenomenon(2B),andthejetwidthof2.3mmwasmeasuredatthepoint(arrow)ofthevena-contractainthiscase,whichwasanalternativetodirect2DEmeasurement2/2/202332LLCHENMDPhDFACC準確測量PDA大小及合適選擇封堵器ThemeasurementsofSDDandMDDin60patientswithafirstorasecondsuccessfulocclusionwere7.1±2.7mm(3.5-17.2mm)and5.4±1.4mm(3.1-10.3mm),respectively(P0.001).Andtherewashighlylinearrelationship(SDD=1.67MDD-2.02,r=0.95,SEE=0.58,P0.01)betweenSDDandMDD2/2/202333LLCHENMDPhDFACC封堵器定位、形態(tài)判斷、占位效應Figure3.Duringtheprocedure,whentheretentiondiskwasdeployed,2DEcouldclearlyrevealedtheextendeddiskagainsttheductampulla(3A);andfurtherwithdrawthedeliverysheathwasindicatedtodeploytheconicalsegmentofthedevice(3B);aproperlypositioningoccluderusuallyshowedanI-shapedappearancewiththeretentiondiskcloselyagainsttheampulla(3C);therewerenotanyADOprotrusionintotheleftpulmonaryartery(3D)2/2/202334LLCHENMDPhDFACC封堵器定位、形態(tài)判斷、占位效應Figure4Onamodifiedsuper-sternallongaxisviewoftheaortaarchwiththeprobetiltedleftward,awell-positioningADO(arrow)wasclearlyseenwithmildoccupationoftheleftpulmonaryarteryin2DEimage(4A),andCDFIdemonstratedlocalflowturbulence(4B),indicatingADO-producedmildstenosisoftheleftpulmonaryartery.Onasuper-sternallongaxisviewoftheaortaarch,anADO(arrow)wasclearlyseenwithmoderateoccupationofthedescendingaortain2DEimage(4C),andCDFIdemonstratedlocalflowturbulence(4D),indicatingADO-producedmoderatestenosisofthedescendingaorta.Theinterrogatedepthwas9cminfigure4C,4D.2/2/202335LLCHENMDPhDFACC殘余分流觀察、更換封堵器Figure5.Ontheleftpanel,CDFIdetectedasmallmarginalresidualshuntwithawidthof0.9mmimmediatelyafterwell-positionofanADO(5A),andCDFIcontinuousmonitoringrevealedtheshuntbecomesmallerat10min(5C)andfinallyvanishedat20min(5E).Conversely,ontherightpanel,CDFIdetectedalargemarginalresidualshuntwithawidthof2.1mmimmediatelyafterwell-positionofanADO(5B),andCDFIcontinuousmonitoringrevealedtheshuntdidnotchangeat10min(5D)andat30min(5F).2/2/202336LLCHENMDPhDFACC2/2/202337LLCHENMDPhDFACC2/2/202338LLCHENMDPhDFACC2/2/202339LLCHENMDPhDFACC2/2/202340LLCHENMDPhDFACCS2及早發(fā)現(xiàn)及有效規(guī)避并發(fā)癥2/2/202341LLCHENMDPhDFACCASD封堵術并發(fā)癥病例—右心氣栓2/2/202342LLCHENMDPhDFACCDualASDoccluders2/2/202343LLCHENMDPhDFACCVSD封堵術并發(fā)癥病例—三尖瓣腱索斷裂2/2/202344LLCHENMDPhDFACCVSD封堵術并發(fā)癥病例—三尖瓣腱索斷裂2/2/202345LLCHENMDPhDFACC準確的封堵器定位、形態(tài)判斷、占位效應Figure4Onamodifiedsuper-sternallongaxisviewoftheaortaarchwiththeprobetiltedleftward,awell-positioningADO(arrow)wasclearlyseenwithmildoccupationoftheleftpulmonaryarteryin2DEimage(4A),andCDFIdemonstratedlocalflowturbulence(4B),indicatingADO-producedmildstenosisoftheleftpulmonaryartery.Onasuper-sternallongaxisviewoftheaortaarch,anADO(arrow)wasclearlyseenwithmoderateoccupationofthedescendingaortain2DEimage(4C),andCDFIdemonstratedlocalflowturbulence(4D),indicatingADO-producedmoderatestenosisofthedescendingaorta.Theinterrogatedepthwas9cminfigure4C,4D.2/2/202346LLCHENMDPhDFACC這是什么？急性肺栓塞2/2/202347LLCHENMDPhDFACC急性主動脈夾層累及RCA這是什么？2/2/202348LLCHENMDPhDFACCS3全數(shù)字便攜彩色多普勒超聲診斷儀

Terasont30002/2/202349LLCHENMDPhDFACC2/2/202350LLCHENMDPhDFACC2/2/202351LLCHENMDPhDFACC2/2/202352LLCHENMDPhDFACCTerasont3000Terasont3000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平臺Duel-CoreCentrino（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織諧波成像技術無OMNI成像軟件**,完整的StressEcho(選配)**更高幀頻**注：主要不同點標記為“**”2/2/202353LLCHENMDPhDFACCTerasont3000Terasont3000加強型原始數(shù)據處理軟件；原始數(shù)據圖