结构性心脏病介入治疗进展 周达新 复旦大学附属中山医院上海市心血管病研究所. Approaches to structural Heart Disease of Intervention

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1 结构性心脏病介入治疗进展 Approaches to structural Heart Disease of Intervention 周达新 复旦大学附属中山医院上海市心血管病研究所

2 Interventional Cath for CHD In 1967 Porstmann helped develop the Ivalon plug and was the first to use it clinically. It was monumental advance in transcatheter intervention of CHD. Ivalon Plug Werner Porstmann ( )

3 Interventional Cath for SHD Surgical Alternatives Balloon Valvuloplasty, Non-Coronary Angioplasty Defect Closure TAVR MR TPAR TR LAA ASAR

4 Balloon Valvuloplasty Balloon Valvuloplasty Pulmonary Aortic Mitral Tricuspid

5 Balloon Valvuloplasty Initial steps Well, I have just got this balloon. Some crazy people are ballooning pulmonary valves.

6 Balloon Valvuloplasty As a consequence, we became involved in congenital pulmonary valvuloplasty.

7 Balloon Valvuloplasty The aortic valve is similar to the pulmonary valvuloplasty, so we became involved in aortic valvuloplasty.

8 Balloon Valvuloplasty Aortic Valvuloplasty Usually bicuspid Ao valve BAV may provide relief for 10+ years in non-calcified valves

9 Balloon Valvuloplasty Thereafter, we pushed the balloon forward. Retrograde Mitral Valvuloplasty

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11 Interventional Cath for CHD Surgical Alternatives Balloon Valvuloplasty Non-Coronary Angioplasty Defect Closure

12 Non-Coronary Angioplasty Non-Coronary Angioplasty Aortic Coarctation Branch PA s Conduit obstruction SVC obstruction IVC obstruction

13 Non-Coronary Angioplasty Pre-dilation Balloon inflation

14 Non-Coronary Angioplasty

15 Non-Coronary Angioplasty Original Anatomy Post-stent

16 Interventional Cath for CHD Surgical Alternatives Balloon Valvuloplasty Non-Coronary Angioplasty Defect Closure

17 Defect Closure Device Closure Coil Embolization Atrial Septal Defect Patent Foramen Ovale Ventricular Septal Defect Patent Ductus Arteriosus Fontan Fenestration Coronary Fistulae Systemic AV Fistulae Pulmonary AV Fistulae Aortopulmonary Collaterals Venous Collaterals

18 Defect Closure ---- PDA Historical Background 1967 Porstmann plug 1979 Rashkind Occluder 1991 BT Device 1992 Gianturco embolization coils 1993 Botallooccluder 1995 SKS Ivalon Plug Device 1995 GGVOD 1996 Detachable coils 1996 Double-cone PFM coils 1998 Amplatzer PDA occluder Psrstmann Rashkind Rao Cambier Verin Schraeder Gritka Tometzki Grabitz Masura

19 Defect Closure ---- PDA PDA Amplatzer Duct Occluder (if no PHT) Amplatzer VSD Occluder (if PHT present) CardioSeal/StarFLEX PDA < 2.5mm Device Selection Detachable Coils Reinforced PFM Coils Gianturco Coils

20 Defect Closure ---- PDA Amplatzer Duct Occluder Nitinol 5-7 Fr Delivery System Sizes: 7mm Long: 6-4 and 8-6mm 8mm Long: 10-8; 12-10; 14-12; 16-14mm Choosing the occluder size in adults: appr. 4mm > measured minimal diameter

21 Defect Closure ---- PDA Modified Angulated Amplatzer Duct Occluder Angled ADO is a modified standard ADO made from a identical material. To avoid protrusion of the device into the aorta, the concave aortic retention disc is angled 32 to the body of the device.

22 Defect Closure ---- PDA PDA Closure in Infants and Small Children with Angled ADO

23 Defect Closure ---- PDA Large PDA with PHT due to large shunts Amplatzer VSD occluder CardioSeal

24 1976 Rashkind Occluder 1989 Clamshell Device 1991 Buttoned device 1993 Angel Wings Occluder 1997 Amplatzer Septal occluder 1998 ASDOS 1998 CardioSEAL

25 Defect Closure ---- ASD/PFO CardioSEAL TM Double Umbrella implant Framework is MP35n Frabric is ployester Flexible, flat, and mostly fabric CardioSEAL in a sheep heart explanted at 90 days.

26 Defect Closure ---- ASD/PFO Amplatzer TM Atrial Septal Occluder Short-connecting waist Nitinol wire Sizes: 4-38mm Self-expanding, self-centering Polyester patches in discs and waist

27 Defect Closure ---- ASD/PFO Amplatzer TM Septal Occluder Implantation

28 Defect Closure ---- ASD/PFO Endothelialized Amplatzer Septal Occluder 6 weeks post-implantation

29 ASD 封堵过程

30 Defect Closure ---- VSD Historical Background 1988 Rashkind double umbrella 1989 Clamshell double umbrella 1994 CardioSEAL 1997 Buttoned device 1998 Gianturco coils Detachable Cook coil 1998 Amplatzer septal occluder 1999 Rashkind Umbrella Device Lock Perry Rigby Sideris Latiff Kalra Masura Arora

31 Defect Closure ---- VSD CardioSEAL TM Double Umbrella implant Frabric is ployester Flexible, flat, and mostly fabric CardioSEAL in a sheep heart explanted at 90 days.

32 Defect Closure ---- VSD Amplatzer TM Ventricular Septal Occluder Nitinol wire Self-expanding, self-centering Polyester patches in discs and waist

33 Defect Closure ---- VSD Endothelialized Amplatzer VSD Occluder

34 Defect Closure ---- VSD Amplatzer TM Septal Occluder Implantation in muscular VSD

35 VSD 封堵过程

36 Coronary Artery Fistula When to use Gianturco coils When the route to the vessel has few bends When guiding catheter can be passed to point of occlusion

37 Coronary Artery Fistula Occlusion with Gianturco Coils

38 Coronary Artery Fistula Occlusion with Controlled-release coils

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42 TAVR 1992 年,andersen 首先成功为猪行 TAVR 术 [1] 2002 年,Cribier 首次成功在人体行 TAVR 术 [2] 近年来又称经导管主动脉瓣置入术 (TAVI)

43 经皮带瓣膜支架发展已历经三代, 目前第三代的代表性产品主要有两种 :Cribier- Edwards 生物瓣 (A) 和 CoreValve 生物瓣 (B) 43

44 瓣膜置入途径 经颈 动脉 入路 经心尖经动脉 ( 股动脉 锁骨下动脉 ) 经静脉 - 房间隔 44

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48 TPAV

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54 LAA

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