心脏外科学讲义英文版.ppt

1、Heart Surgery,WuChangXue Dept of thoracic cardiovasclar surgery,LZMC,PA blood increase,Blood shut from left heart system to right at atrial, ventricular or great artery levelPDAASDVSDAV canal defect,PDA-Patent ductus ateriosus,role of ductus arteriosusLocationRecurrent laryngeal nerveFail to close a

2、fter 3 months,Funnel,Physiology of PDA,Diagnosis of PDA,Body sign: continous machinery murmur SBP-DBP increase LV enlargeElectric cardiographyEchocardiographyX-rayCardiac catheterization,Treatment of PDA,Complication of PDA ligation,BleedingRecurrent laryngeal nerve injuryAneurism ReopenReflective h

3、igh blood pressureother,ASD,Premum partial atrial ventricular canal defectSecundem ostium SVC IVC mixed CS,Pathophysiology of ASD,L-R shuntingPulmonary hypertensionP vascular disEisenmenger syndrome,Disgnosis of ASD,Physical exam: SM, P2Subtle sign of heart failure: exercise ,palpitation,arrhythmias

4、Echo CG Electric CGcatheterization,treatment,PFO:80% spontaneous closure in 1st.closure for :symppomatic patients significant ASD L-R shunt over 1.5:1Closure way: surg percutaneous transcatheter device transthoracic catheter device transthoracic scope assisted,VSD,PerimembranousMuscularSubarterial A

5、trioventricular,Pathophysiology of VSD,L-R shunting P blood increaseLV volume overloadPHEisenmenger syndrome,Disgnosis of VSD,Physical exam: SM, P2Subtle sign of heart failure: exercise intolerance,palpitation, arrhythmiasEcho CG Electric CGcatheterization,Treatment,Spontanous clsoureclosure for :sy

6、mppomatic patients large VSDClosure way: surg percutaneous transcatheter device transthoracic catheter device transthoracic scope assisted,Surg for VSD,Heart incisionPatchComplication,TOF,VSDAortic overidingRVOTORV hypertrophy combined abnormalities,Disgnosis of TOF,Clinical: symptoms( cyanosis, ano

7、xia spell, exercise intolerance, squat ) body sign( dysplasia, cyanosis, pestle loke finger , heart check)X-ray: boot shapeEcho CG Electric CGcatheterization,Rescue for TOF spell,Knee-to-chest OxygenSedation: morphineVolume expansionIncrease cardiac preload and systemic resistance,Surgery for TOF,Tw

8、o stage: classic and modified blalock-taussing shuntSingle stage: VSD closure+ RVOTO relief,Valve Disease,CongenitalRheumaticDegenerativeInfectionImmune,Mitral valve stenosis,MS,Valvular lesions free edge echo intensity, thickening, valvular adhesion, opening area is reduced： minor：1.52.0 cm2 modera

9、te：1.01.5 cm2 severe：1.0 cm2,Ppv,Whole heart failure,MS,PGa-v,PH,RV ,LA ,RV failure,LV failure,Clinical Manifestations,Symptoms (1) Dyspnea: The earliest symptoms; (2) hemoptysis, bloody sputum; (3) cough; (4) hoarseness;(Signs (1) mitral valve face. (2) signs of heart mitral stenosis; apex beat is

10、not obvious; S1 loud; DM. (3) pulmonary hypertension and right ventricular dilatation,Echo,N,Ms,N,Ms,Aortic stenosis（AS）,EtiologyCongenital: Congenital hypoplasia of the aortic valve, two lobes or multiple lobes; subvavular located stenosis;Acquired: rheumatic or senile degeneration,Pathology and he

11、modynamic changes,An aortic valve itself increased pressure load,AS,LVH,LHF,Increase in myocardial oxygen consumption,Intracardiac diastolic pressure,Coronary perfusion,Myocardial ischemia,Clinical Infestation,Symptoms: Dyspnea, angina, syncopeSigns: Systolic murmur,Aortic valve opening is limited,Left ventricular wall thickeningMotion Enhanced,the best readily conduit,venasaphenamagna,Internal mammary artery,