循环系统内科学课件：interventional cardiology.ppt

1、Interventional CardiologyHesong ZengIntroduction:1. Use of Cardiac pacemakers and Antiarrhythmia Devices2. Percutaneous coronary intervention3. Percutaneous valvular intervention4. Interventional treatment for congenital heart disease(一一) Cardiac pacemakers1. Introduction: Permanent, Temporary 2. Cl

2、assification: AAI(T) ,VVI(T), DDDThe meaning of the code in the pacemakers: The first letter: Chamber paced The second letter: Chamber sensed The third letter: Response to sensing3. Indications for cardiac pacing:Acquired AV blockCongenital complete heart blockChronic bifascicular and trifascicular

3、blockSinus Node dysfunction（）（）Hypersensitive carotid sinus syndrome and neurally mediated syncopeHypertrophic cardiomyopathyDilated cardiomyopathyCardiac transplantationPrevent tachycardiaAutomaticlly detect and terminate tachycardiasComplicationImplant related complicationLead-related complication

4、Pacemaker system infectionMultisite cardiac pacing Biatrial pacing Biventricular pacing Implantable cardioverter defibrillator therapyIndication:Secondary prevention of sudden cardiac deathFollow-upComplication（二）（二）Radio frequency ablation therapy for cardiac arrhythmias 1. Radio Frequency catheter

5、 ablation of accessory pathways 2. Radio Frequency catheter modification of AV node for AVNRTS(AV node reentrant tachycardia)3. Radio Frequency catheter ablation of atrial tachycardia, sinus node reentry/inappropriate sinus tachycardia4. Radio Frequency catheter ablation of atrial flutter5. Radio Fr

6、equency catheter ablation of atrial fibrillation6. Radio Frequency catheter ablation of ventricular tachycardia(三）三）Percutaneous coronary intervention1.Balloon PTCA2. Coronary atherectomy Directional coronary atherectomy Rotational atherectomy Transluminal extraction atherectomy3. Ablative laser-ass

7、isted angioplasty4.Catheter-based thrombolysis and mechanical thrombectomy5.Coronary stentsIndications for percutaneous coronary interventions:1. Angina2. AMIl左主干，LMTl左前降支，left anterior descending，LADl左回旋支，left circumflex，LCXl对角支，diagonal branch，Dl右冠状动脉，right coronary artery，RCAl后降支，右室支，etc99% steno

8、sisStentMonitor system 30156.505101520253035Short-term mortality(%)Short-term mortality(%)Pre CCU eraPre CCU eraCCU eraCCU eraReperfusionReperfusioneraeraDefibrillationHemodynamic monitoringBeta blockadeThrombolysisPCIThe Mortality of AMI in Different EraACC/AHA ACC/AHA ：Time is lifeTime is lifePrep

9、aration of The Procedure 1General preparation 2. Medicine used before the procedure Aspirin Ticlopidine GPb/a inhibitors: EPIC，Eptifibatide，Tirofiban Management in the procedure of PCI1Choice of contrast media2Pacemaker in the procedure3Medicine in the procedure Heperine Management after the procedu

10、reMyocardium protection during the procedure of acute PTCA 1Intra-aortic balloon pump(IABP)2Percutaneous cardiopulmonary bypass support (CPS) Criteria for the successful acute PTCA1. TIMI grade 2 flow 2. Residual stenosis 30%)Important coronary artery lesionContraindications：（四）（四）Percutaneous Valvu

11、loplasty Mitral Valvuloplasty Aortic Valvuloplasty(五五). Interventional treatment for congenital heart disease Atrial septal defect Ventricular septal defect Patent Ductus ArteriosusASD(A) The Amplazter ASD occluder device (B) The Helex septal occluder device Amplatzer occluder device (六六). Percutane

12、ous transluminal septal myocardial ablation Hypertrophic cardiomyopathy 七、The othersRight renal artery 80% stenosis Hypertension 1. Use of Cardiac pacemakers and Antiarrhythmia Devices2. Percutaneous coronary intervention3. Percutaneous valvular intervention4. Percutaneous transluminal septal myocardial ablation5. Interventional treatment for congenital heart disease