先心病介入治疗解剖.ppt

先心病介入治疗解剖基础 方臻飞 意义 先心病介入治疗的基础 有助于更好的超声诊断 有助于CTA、MRA及DSA影像诊断 指导适应症的筛选和并发症的防治 相关学科 组织胚胎学 解剖学 超声诊断 影像诊断 心外科 先心病介入治疗 动脉导管未闭 This 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 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 fenestrations 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 case two separate holes have formed, making interventional closure a more difficult procedure A) 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 oval fossa. Extracardiac fibrofatty tissue (yellow) incorporated into the superior rim of the septum * * 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: 332-343 Anderson的VSD分类 VSD分型 VSD分型 Ventricular septal defects:how shall we describe,name and classify them? Van Praagh R,Geva T,kreutzer J. J Am Coll Cardiol 1989,14:1298-1299 Van Praagh的VSD分类 VSD分型 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 膜周部VSD周缘因三尖瓣遮挡，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