实时三维超声心动图叶维国.pptx

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1、实时三维超声心动图叶维国实时三维超声心动图叶维国完整关护周期新理念完整关护周期新理念预防预防预防预防筛查筛查筛查筛查诊断诊断诊断诊断治疗治疗治疗治疗二级预防二级预防二级预防二级预防治疗及随访治疗及随访治疗及随访治疗及随访家庭照顾家庭照顾家庭照顾家庭照顾实时三维超声实时三维超声实时三维超声实时三维超声第1页/共63页概述概述三维超声心动图的应用三维超声心动图的应用 左心室形态，功能和质量左心室形态，功能和质量左心室形态，功能和质量左心室形态，功能和质量 左心室局部及不同步的评估左心室局部及不同步的评估左心室局部及不同步的评估左心室局部及不同步的评估 右心室容积及功能右心室容积及功能右心室容积及功

2、能右心室容积及功能 心房容积心房容积心房容积心房容积 心脏瓣膜病心脏瓣膜病心脏瓣膜病心脏瓣膜病 二尖瓣病变（二尖瓣狭窄二尖瓣病变（二尖瓣狭窄二尖瓣病变（二尖瓣狭窄二尖瓣病变（二尖瓣狭窄/脱垂或者脱垂或者脱垂或者脱垂或者连连连连枷瓣枷瓣枷瓣枷瓣/缺血缺血缺血缺血所致二尖瓣反流）所致二尖瓣反流）所致二尖瓣反流）所致二尖瓣反流）主动脉狭窄，三尖瓣瓣膜病主动脉狭窄，三尖瓣瓣膜病主动脉狭窄，三尖瓣瓣膜病主动脉狭窄，三尖瓣瓣膜病 心内介入治疗心内介入治疗心内介入治疗心内介入治疗第2页/共63页概述概述三维超声心动图的应用三维超声心动图的应用 左心室形态，功能和质量左心室形态，功能和质量左心室形态，功能和质

3、量左心室形态，功能和质量 左心室局部及不同步的评估左心室局部及不同步的评估左心室局部及不同步的评估左心室局部及不同步的评估 右心室容积及功能右心室容积及功能右心室容积及功能右心室容积及功能 心房容积心房容积心房容积心房容积 心脏瓣膜病心脏瓣膜病心脏瓣膜病心脏瓣膜病 二尖瓣病变（二尖瓣狭窄二尖瓣病变（二尖瓣狭窄二尖瓣病变（二尖瓣狭窄二尖瓣病变（二尖瓣狭窄/脱垂或者脱垂或者脱垂或者脱垂或者连迦连迦连迦连迦瓣瓣瓣瓣/缺血缺血缺血缺血所致二尖瓣反流）所致二尖瓣反流）所致二尖瓣反流）所致二尖瓣反流）主动脉狭窄，三尖瓣瓣膜病主动脉狭窄，三尖瓣瓣膜病主动脉狭窄，三尖瓣瓣膜病主动脉狭窄，三尖瓣瓣膜病 心内介入

4、治疗心内介入治疗心内介入治疗心内介入治疗第3页/共63页经皮心腔内介入治疗经皮心腔内介入治疗二尖瓣外科治疗二尖瓣外科治疗(二尖瓣狭窄二尖瓣狭窄/二尖瓣脱二尖瓣脱垂垂/连枷瓣连枷瓣/缺血性二尖瓣反流缺血性二尖瓣反流)经皮二尖瓣钳经皮二尖瓣钳MitraClip system 经皮二尖瓣球囊扩张术经皮二尖瓣球囊扩张术(PBMV)监测二尖瓣修复监测二尖瓣修复/置换外科手术后监测置换外科手术后监测效果效果经皮主动脉瓣置换经皮主动脉瓣置换房间隔缺损房间隔缺损/卵圆孔封堵卵圆孔封堵左心耳封堵左心耳封堵第4页/共63页术术 中中从左心房侧从左心房侧从左心房侧从左心房侧从左心房侧从左心房侧从左心房侧从左心房侧R

5、obert Lang 医生惠赠医生惠赠University of Chicago第5页/共63页双叶人工机械瓣双叶人工机械瓣从左心房侧从左心房侧从左心房侧从左心房侧从左心室侧从左心室侧从左心室侧从左心室侧Robert Lang 医生惠赠医生惠赠University of Chicago第6页/共63页二尖瓣生物瓣狭窄二尖瓣生物瓣狭窄从左心房侧从左心房侧从左心房侧从左心房侧从左心室侧从左心室侧从左心室侧从左心室侧Robert Lang 医生惠赠医生惠赠University of Chicago第7页/共63页经皮二尖瓣钳经皮二尖瓣钳(EValve)第8页/共63页Vahanian 及及 Broc

6、het医生惠赠医生惠赠Bichat Hospital,Paris,France二二尖尖瓣瓣狭狭窄窄经经皮皮球球囊囊扩扩张张术术第9页/共63页二尖瓣狭窄经皮球囊扩张术二尖瓣狭窄经皮球囊扩张术扩张前扩张后Vahanian 及及 Brochet医生惠赠医生惠赠Bichat Hospital,Paris,France第10页/共63页二尖瓣二尖瓣+主动脉瓣换瓣后主动脉瓣换瓣后3个月心力衰竭症状个月心力衰竭症状第11页/共63页二尖瓣机械瓣开裂二尖瓣机械瓣开裂:左心房面左心房面二尖瓣机械瓣二尖瓣机械瓣主动脉瓣机械瓣主动脉瓣机械瓣第12页/共63页三维彩色血流示瓣周漏三维彩色血流示瓣周漏倾斜的左心房面倾

7、斜的左心房面:三维血流束定位三维血流束定位左心室面左心室面:有效的反流口面积有效的反流口面积第13页/共63页面积面积=0.51 cm2第14页/共63页经皮二尖瓣机械瓣开裂处修补经皮二尖瓣机械瓣开裂处修补经皮二尖瓣机械瓣开裂处修补经皮二尖瓣机械瓣开裂处修补Garcia FernandezGarcia Fernandez医生惠赠医生惠赠医生惠赠医生惠赠,Spain,Spain第15页/共63页经皮主动脉机械瓣开裂处修补经皮主动脉机械瓣开裂处修补经皮主动脉机械瓣开裂处修补经皮主动脉机械瓣开裂处修补Garcia Fernandez医生惠赠医生惠赠,Spain第16页/共63页术前术前Dr.Blaz

8、er Dr.Blazer 惠赠，惠赠，惠赠，惠赠，Aachen UniversityAachen University 第17页/共63页术后术后Dr.Blazer Dr.Blazer 惠赠，惠赠，惠赠，惠赠，Aachen UniversityAachen University 第18页/共63页卵圆孔未闭卵圆孔未闭左心房面左心房面左心房面左心房面左心室面左心室面左心室面左心室面房间隔房间隔房间隔房间隔卵圆孔卵圆孔卵圆孔卵圆孔Robert Lang Robert Lang 医生惠赠医生惠赠医生惠赠医生惠赠University of ChicagoUniversity of Chicago第19

9、页/共63页卵圆孔未闭卵圆孔未闭Robert Lang 医生惠赠医生惠赠University of Chicago第20页/共63页上腔静脉上腔静脉三尖瓣三尖瓣主动脉主动脉房间隔缺损房间隔缺损房间隔缺损房间隔缺损:外科医生切面外科医生切面外科医生切面外科医生切面 Robert Lang 医生惠赠医生惠赠University of Chicago第21页/共63页导引钢丝和鞘管放置导引钢丝和鞘管放置经食管超声图像经食管超声图像经心腔内超声图像经心腔内超声图像从右心房侧从右心房侧 从左心房侧从左心房侧 第22页/共63页封堵器释放封堵器释放从右心房侧从右心房侧从右心房侧从右心房侧从左心房侧从左心房

10、侧从左心房侧从左心房侧Robert Lang 医生惠赠医生惠赠University of Chicago第23页/共63页封堵器位置评价封堵器位置评价Robert Lang 医生惠赠医生惠赠University of Chicago左心房伞左心房伞右心房伞右心房伞第24页/共63页三维经食管超声心动图介入术中应用三维经食管超声心动图介入术中应用三维经食管超声心动图介入术中应用三维经食管超声心动图介入术中应用卵圆孔封堵卵圆孔封堵卵圆孔封堵卵圆孔封堵Andreas FrankeAndreas Franke惠赠惠赠,University of Aachen,University of Aachen第

11、25页/共63页左心耳左心耳(左心房切面左心房切面)正视切面正视切面89%Robert Lang 医生惠赠医生惠赠University of Chicago第26页/共63页左心耳封堵左心耳封堵(Watchman)LAA sideLA sidePTFE membraneNitinolFrameAnchorsLA sideLAA sideBarbsNitinol framePolyethylene membrane第27页/共63页展望未来展望未来小型化小型化小型化小型化(儿科儿科儿科儿科,心腔内超声心腔内超声心腔内超声心腔内超声)更好的时间及空间分辨率更好的时间及空间分辨率更好的时间及空间分辨

12、率更好的时间及空间分辨率单个心动周期广角实时单个心动周期广角实时单个心动周期广角实时单个心动周期广角实时+/-+/-血流显像血流显像血流显像血流显像组织多普勒组织多普勒组织多普勒组织多普勒/应变应变应变应变 (经食管超声心动图经食管超声心动图经食管超声心动图经食管超声心动图)软件软件软件软件l l动态二尖瓣分析动态二尖瓣分析动态二尖瓣分析动态二尖瓣分析l l左心室功能及力学左心室功能及力学左心室功能及力学左心室功能及力学l l右心室定量右心室定量右心室定量右心室定量l l与其他三维显像的结合与其他三维显像的结合与其他三维显像的结合与其他三维显像的结合(心脏磁共振心脏磁共振心脏磁共振心脏磁共振/

13、CT)/CT)第28页/共63页Conclusions在过去在过去20年中，三维超声心动图取得了革命年中，三维超声心动图取得了革命性的进步，促进了疾病早期筛查、诊断、治性的进步，促进了疾病早期筛查、诊断、治疗引导和效果监测疗引导和效果监测技术不断进步将继续惠及患者技术不断进步将继续惠及患者第29页/共63页第30页/共63页第31页/共63页“Minimally Invasive Interventions”Live 3D Echo:Age of Coming 20th20th GWICC GWICC Saturday,October 10,2009Saturday,October 10,20

14、09Gabriel Yip,MGabriel Yip,MD FASE FACCD FASE FACCAssociate Professor,Division of CardiologyAssociate Professor,Division of CardiologyDepartment of Medicine&Therapeutics Department of Medicine&Therapeutics The Chinese University of Hong KongThe Chinese University of Hong KongPrince of Wales Hospital

15、,Hong Kong,ChinaPrince of Wales Hospital,Hong Kong,China第32页/共63页Care Cycle Concepts PreventionPreventionScreeningScreeningDiagnosisDiagnosisTreatmentTreatmentSecondary PreventionSecondary PreventionManagement&Follow-upManagement&Follow-upHome CareHome CareLive 3D Live 3D EchoEcho第33页/共63页Applicatio

16、ns of 3D EchocardiographyLV Geometry,Function and MassLV Regional and Dyssynchrony AssessmentRV volumes and functionAtrial volumesValvular heart disease Mitral valve(MS/MVP&Flail/Ischemic MR)Aortic Stenosis,Tricuspid Valve DiseaseGuiding percutaneous interventions第34页/共63页Applications of 3D Echocard

17、iographyLV Geometry,Function and MassLV Regional and Dyssynchrony AssessmentRV volumes and functionAtrial volumesValvular heart disease Mitral valve(MS/MVP&Flail/Ischemic MR)Aortic Stenosis,Tricuspid Valve DiseaseGuiding percutaneous interventions第35页/共63页Percutaneous Intracardiac InterventionMitral

18、 Valve Surgery(MS/MVP Flail/Ischemic MR)Mitral Valve Surgery(MS/MVP Flail/Ischemic MR)Percutaneous MitraClip system Percutaneous MitraClip system Percutaneous balloon mitral valvuloplasty(PBMV)Percutaneous balloon mitral valvuloplasty(PBMV)Monitor surgical outcome after repair/replacementMonitor sur

19、gical outcome after repair/replacementPercutaneous aortic valve replacementPercutaneous aortic valve replacementASD/PFO closureASD/PFO closureLeft atrial appendage occlusionLeft atrial appendage occlusion第36页/共63页During-SurgeryFrom LAFrom LAFrom LAFrom LACourtesy:Dr.Robert LangUniversity of Chicago第

20、37页/共63页Bileleaflet Mechanical ProsthesisFrom LAFrom LAFrom LVFrom LVCourtesy:Dr.Robert LangUniversity of Chicago第38页/共63页Stenotic Bioprosthetic MVFrom LAFrom LAFrom LVFrom LVCourtesy:Dr.Robert LangUniversity of Chicago第39页/共63页Percutaneous MitraClip(EValve)第40页/共63页Courtesy of Dr Vahanian and Dr Br

21、ochetBichat Hospital,Paris,FrancePBMV in Mitral Stenosis第41页/共63页PBMV in Mitral StenosisPRE PBMVPRE PBMVPOST PBMVPOST PBMVCourtesy of Dr Vahanian and Dr BrochetBichat Hospital,Paris,France第42页/共63页Heart Failure Symptoms 3 months S/P MVR+AVR第43页/共63页Dehiscence of Mitral Prosthesis:Left Atrial Perspec

22、tiveMitral prosthesisAortic prosthesis第44页/共63页3D Color Flow of Periprosthetic RegurgitationOblique LA perspective:3D Jet orientationLV perspective:Effective regurgitation orifice area第45页/共63页Area=0.51 cm2第46页/共63页Courtesy Dr Garcia Fernandez,SpainCourtesy Dr Garcia Fernandez,SpainP Pe er rc cu ut

23、ta an ne eo ou us s R Re ep pa ai ir r o of f P Pr ro os st th he et ti ic c MMi it tr ra al l V Va al lv ve e D De eh hi is sc ce en nc ce e第47页/共63页Percutaneous Repair of Prosthetic Aortic Valve DehiscenceCourtesy Dr Garcia Fernandez,SpainCourtesy Dr Garcia Fernandez,Spain第48页/共63页Before implantat

24、ionCourtesy:Dr.Blazer,Aachen University Courtesy:Dr.Blazer,Aachen University 第49页/共63页Post implantationCourtesy:Dr.Blazer,Aachen University Courtesy:Dr.Blazer,Aachen University 第50页/共63页Patent Foramen OvaleLA viewLA viewLV viewLV viewIASIASPFOPFOCourtesy:Dr.Robert LangUniversity of Chicago第51页/共63页P

25、atent Foramen OvaleCourtesy:Dr.Robert LangUniversity of Chicago第52页/共63页SVCTVAOASD:The Surgeons View ASD:The Surgeons View Courtesy:Dr.Robert Lang,University of Chicago第53页/共63页ICE imageICE imageTEE imageTEE imageView from RAView from RAView from LAView from LAGuidewire and Sheath PlacementCourtesy:

26、Dr.Robert LangUniversity of Chicago第54页/共63页Device DeploymentFrom RAFrom RAFrom LAFrom LA第55页/共63页Evaluation Device PositionEvaluation Device PositionRA discRA discLA discLA disc第56页/共63页Peri-interventional 3D TEE PFO ClosureCourtesy:Andreas Franke,University of AachenCourtesy:Andreas Franke,Univers

27、ity of Aachen第57页/共63页Left Atrial Appendage(LA view)En-face view89%第58页/共63页Left Atrial Appendage OccluderLAA sideLA sidePTFE membraneNitinolFrameAnchorsLA sideLAA sideBarbsNitinol framePolyethylene membrane第59页/共63页Whats Next?Miniaturization(for pediatrics,ICE)Miniaturization(for pediatrics,ICE)Bet

28、ter time and spatial resolutionBetter time and spatial resolutionWider Angle Real-time Single beat+/-Color Wider Angle Real-time Single beat+/-Color FlowFlowTissue Doppler/Strain(TEE)Tissue Doppler/Strain(TEE)SoftwareSoftwarel lDynamic MV analysisDynamic MV analysisl lLV function and mechanicsLV fun

29、ction and mechanicsl lRV quantitationRV quantitationl lFusion with other 3D imaging(CMR/CT)Fusion with other 3D imaging(CMR/CT)第60页/共63页ConclusionsOver past 20 years,remarkable evolution in 3D echocardiography that has enhanced early screening,diagnosis,guiding treatment,and monitoringIt is expected the trend of improvement will continue to grow with ultimate benefits to patients第61页/共63页第62页/共63页