先天性心臟病封堵治療基礎(chǔ)超聲影像

先天性心臟病封堵治療基礎(chǔ)超聲影像先天性心臟病封堵治療基礎(chǔ)超聲影像先天性心臟病封堵治療基礎(chǔ)超聲影像導(dǎo)管室彩色多普勒超聲的作用

術(shù)前診斷/術(shù)中監(jiān)測(cè)/術(shù)后評(píng)價(jià)介入治療引導(dǎo)監(jiān)測(cè)先天性心臟病—封堵治療瓣膜性心臟病—擴(kuò)張成形肥厚型心肌病—消融治療擴(kuò)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(dòng)脈夾層血腫急性肺動(dòng)脈栓塞重癥心肌心包炎嚴(yán)重張力性氣胸導(dǎo)管并發(fā)癥早發(fā)現(xiàn)心包填塞心臟破裂接觸血栓腔內(nèi)氣栓術(shù)后療效評(píng)價(jià)優(yōu)化影像形態(tài)學(xué)評(píng)估血流動(dòng)力學(xué)評(píng)估器械是否需更換術(shù)式是否需改變術(shù)后治療關(guān)注點(diǎn)11/17/20202LLCHENMDPhDFACC導(dǎo)管室彩色多普勒超聲的作用

術(shù)前診斷/術(shù)中監(jiān)測(cè)/術(shù)后評(píng)價(jià)介入治療引導(dǎo)監(jiān)測(cè)先天性心臟病—封堵治療瓣膜性心臟病—擴(kuò)張成形肥厚型心肌病—消融治療擴(kuò)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(dòng)脈夾層血腫急性肺動(dòng)脈栓塞重癥心肌心包炎嚴(yán)重張力性氣胸導(dǎo)管并發(fā)癥早發(fā)現(xiàn)心包填塞心臟破裂接觸血栓腔內(nèi)氣栓術(shù)后療效評(píng)價(jià)優(yōu)化影像形態(tài)學(xué)評(píng)估血流動(dòng)力學(xué)評(píng)估器械是否需更換術(shù)式是否需改變術(shù)后治療關(guān)注點(diǎn)2/2/20232LLCHENMDPhDFACCS1術(shù)中引導(dǎo)監(jiān)測(cè)2/2/20233LLCHENMDPhDFACC1.導(dǎo)管房間隔缺損封堵術(shù)2/2/20234LLCHENMDPhDFACC術(shù)前ASD超聲評(píng)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(zhǎng)最大ADO缺損直徑解剖擴(kuò)張缺損邊緣有無(wú)厚薄周?chē)Y(jié)構(gòu)PVCSSVC\IVCMV\TVAB2/2/20236LLCHENMDPhDFACC劍下四腔觀AB房間隔全長(zhǎng)最大ADO缺損直徑解剖擴(kuò)張缺損邊緣有無(wú)厚薄周?chē)Y(jié)構(gòu)PVCSSVC\IVCMV\TV2/2/20237LLCHENMDPhDFACC心底短軸觀主動(dòng)脈對(duì)側(cè)房缺邊緣長(zhǎng)度主動(dòng)脈側(cè)房缺邊緣長(zhǎng)度周?chē)Y(jié)構(gòu)主動(dòng)脈根部SVCMVAB2/2/20238LLCHENMDPhDFACC劍下下腔觀AB房間隔缺損在IVC側(cè)邊緣殘端有無(wú)厚薄IVC側(cè)邊緣無(wú)殘端容易導(dǎo)致封堵失敗2/2/20239LLCHENMDPhDFACC術(shù)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(guò)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(guò)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(guò)牽/拉輸送系統(tǒng)AB確定封堵器是否夾住主動(dòng)脈側(cè)房缺殘端或抱住主A根部確定封堵器是否夾住主動(dòng)脈對(duì)側(cè)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(shù)后ASD封堵效果觀察2/2/202315LLCHENMDPhDFACC心尖四腔及大動(dòng)脈短軸觀補(bǔ)片位置和形態(tài)良好對(duì)二、三尖瓣無(wú)影響對(duì)肺靜脈回流無(wú)影響良好環(huán)抱主動(dòng)脈AB2/2/202316LLCHENMDPhDFACC2.經(jīng)導(dǎo)管VSD封堵術(shù)2/2/202317LLCHENMDPhDFACC術(shù)前VSD超聲評(píng)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(lèi)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(dòng)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(zhǎng)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(guān)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(zhǎng)軸切面室間隔缺損邊緣距主動(dòng)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(guān)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(nèi)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(shù)中VSD封堵超聲監(jiān)測(cè)封堵過(guò)程是否影響重要結(jié)構(gòu)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(dǎo)管穿過(guò)室間隔觀察出鞘的封堵器是否影響二尖瓣腱索引起關(guān)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(dòng)脈瓣關(guān)閉不全是否觸及主動(dòng)脈竇是否影響主動(dòng)脈瓣關(guān)閉觀察封堵器是否引起三尖瓣關(guān)閉不全三尖瓣腱索被夾，斷裂低血壓2/2/202326LLCHENMDPhDFACC左室長(zhǎng)軸切面觀察封堵器是否引起主動(dòng)脈瓣關(guān)閉不全，是否觸及主動(dòng)脈竇或引起主動(dòng)脈竇變形2/2/202327LLCHENMDPhDFACC封堵效果與并發(fā)癥術(shù)后VSD封堵效果觀察2/2/202328LLCHENMDPhDFACC成功封堵封堵器位置良好無(wú)主動(dòng)脈瓣返流無(wú)三尖瓣返流無(wú)主動(dòng)脈竇變形可釋放封堵器2/2/202329LLCHENMDPhDFACC3.超聲引導(dǎo)PDA封堵術(shù)2/2/202330LLCHENMDPhDFACC測(cè)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(zhǔn)確測(cè)量PDA大小Figure2.2DEdidnotcompletelyrevealtheductmorphologyinapatientwithasmallPDA(2A);whileCDFIclearlydetectedaductshuntingjetenteringthepulmonaryarteryfromthedescendingaorta,producingavena-contractaphenomenon(2B),andthejetwidthof2.3mmwasmeasuredatthepoint(arrow)ofthevena-contractainthiscase,whichwasanalternativetodirect2DEmeasurement2/2/202332LLCHENMDPhDFACC準(zhǔn)確測(cè)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(yīng)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(yīng)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(shù)并發(fā)癥病例—右心氣栓2/2/202342LLCHENMDPhDFACCDualASDoccluders2/2/202343LLCHENMDPhDFACCVSD封堵術(shù)并發(fā)癥病例—三尖瓣腱索斷裂2/2/202344LLCHENMDPhDFACCVSD封堵術(shù)并發(fā)癥病例—三尖瓣腱索斷裂2/2/202345LLCHENMDPhDFACC準(zhǔn)確的封堵器定位、形態(tài)判斷、占位效應(yīng)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(dòng)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(qiáng)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(tái)Duel-CoreCentrino（迅馳）配置、WindowsXP平臺(tái)**全息數(shù)碼成像技術(shù)軟件全息數(shù)碼成像技術(shù)軟件專(zhuān)利技術(shù)數(shù)碼多聲束形成技術(shù)專(zhuān)利技術(shù)數(shù)碼多聲束形成技術(shù)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(dòng)態(tài)均勻聚焦全程動(dòng)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(shí)時(shí)三同步功能軟件實(shí)時(shí)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(zhuǎn)取樣）全息解剖M型（取樣線可作360度旋轉(zhuǎn)取樣）彩色能量多普勒

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、彩色方向性能量多普勒軟件PW/CW多普勒血流測(cè)量與分析PW/CW多普勒血流測(cè)量與分析組織多普勒（TDI）組織多普勒（TDI）組織諧波成像技術(shù)組織諧波成像技術(shù)無(wú)OMNI成像軟件**,完整的StressEcho(選配)**更高幀頻**注：主要不同點(diǎn)標(biāo)記為“**”2/2/202353LLCHENMDPhDFACCTerasont3000Terasont3000加強(qiáng)型原始數(shù)據(jù)處理軟件；原始數(shù)據(jù)圖