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先心病外科残留病变的介入治疗.ppt

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先心病外科殘留病變的介入治療周啟東醫生翁德璋醫生香港大学葛量洪医院小儿心脏科DivisionofPaediatricCardiology,GranthamHospitalDepartmentofPaediatricsandAdolescentMedicine,TheUniversityofHongKongThe10thSouthChinaInternationalCongressofCardiology第十屆中國南方國際心血管病學術會議

ComplexityofcongenitalheartoperationvarieswidelySimpleDuctsarteriosusligationAtrialseptaldefectclosureVentricularseptaldefectclosureModeratetoHighlycomplexShuntoperationsRepairofcoarctationofaortaTetralogyofFallotrepairRastellioperationFontan-likeoperationArterialswitchKonnooperationRossprocedureNorwoodoperation

ResidualLesionsafterCardiacSurgeryforCongenitalHeartDiseaseResidualshuntingVentricularoutflowtractobstructionResidualbloodvesselstenosisResidualvalvarlesionsVentriculardysfunctionCardiacarrhythmias

TreatmentofResidualLesionsafterCardiacSurgeryMedicaltherapySurgicaltreatmentDeviceimplantationforrhythmdisturbanceInterventionalcardiaccatheterization(IVC)

ResidualStructuralLesionsMedicaltherapyNotcurative,temporarySurgicaltreatmentConventionalInterventionalcardiaccatheterization(IVC)Widelyacceptedfortreatmentofnativelesions e.g.PDA,ASDocclusion,valveandvesseldilatationsApplicablealsototreatresidualstructurallesions

AdvantagesofInterventionalcardiaccatheterization(IVC)oversurgicaltreatmentforresidualstructurallesions:IVC:lessinvasive,lessmorbiditythansurgeryIVC:moresimplethansurgerye.g.correctionofstenoticvesselsSomelesionsaremoreaccessiblebycathetere.g.peripheralbranchpulmonaryarterystenosisSomelesionsaremoredifficulttodefineclearlyduringsurgerybecauseofcomplexanatomy,oranatomydistortedbyperviousprocedures

Interventionalcardiaccatheterization(IVC)andSurgicaltreatmentarecomplimentary:IVCcannotreplacesurgeryIVCisnotsuitabletocorrectcertainlesionse.g.valveregurgitationsExperienceandskillofoperatoriskeyorlimitingfactortosuccessofIVCAvailabilit

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