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1、外科治療的心血管疾病心外科DeptofCardiovascularSurgery席振山教授ProfessorXiZhenshan一、先天性心臟病Congenitalheartdiseases1肺動脈狹窄(pulmonarystenosis)震顫(tremor)、雜音(murmur)：L2、SM、P2↓X線片(X-ray)：肺血少、右心大、肺動脈窄后擴張心電圖(ECG)：肺型P、電軸右偏、右室肥大超聲心動圖(Echocardiography)心導管和心血管造影(cardiaccatheterizati
2、onandcardioangiography)CT的MRI顯示肺動脈及其分支治療(treatment)閉式肺動脈瓣切開(closedpulmonaryvalvulotomy)直視肺動脈瓣切開(pulmonaryvalvulotomyunderdirectvision)常溫或低溫體外循環(huán)流出道梗阻解除2動脈導管未閉(PatentDuctusArteriosus)舉例：動脈導管未閉(PDA)病理解剖(pathologicoanatomic)（圖2）血流動力學(hemodynamics)和臨床表現(xiàn)分流量(
3、shuntvolume)的多少取決：主-肺動脈壓力差大小導管直徑粗細肺血管阻力高低震顫(tremor)雜音(murmur)心電(ECG)X線片(X-ray)超聲心動圖(echocardiography)心導管及心血管造影(cardiaccatheterizationandcardioangiography)治療(treatment)導管結扎(ductusligation)導管切斷(ductusamputation)體外導管縫合(suture)胸腔鏡導管閉合導管阻塞3房間隔缺損(AtrialSepta
4、lDefect)舉例：房間隔缺損(ASD)病理解剖特點(pathologicoanatomic)（圖3）血流動力學(hemodynamics)和臨床表現(xiàn)癥狀(signs)雜音(murmur)：L2、SM、P2↑X線片(X-ray)心電圖(ECG)超聲心動圖(echocardiography)心導管及心血管造影(cardiaccatheterizationandcardioangiography)治療低溫阻斷房間隔縫合深低溫停循環(huán)房間隔修補體外循環(huán)房間隔缺損修補房間隔傘修補術4室間隔缺損(Ventri
5、cularSeptalDefect)病理解剖特點(pathologicoanatomic)（圖4）血流動力學(hemodynamics)和臨床表現(xiàn)震顫(tremor)、雜音(murmur)：L3、4SMX線片(X-ray)心電圖(ECG)超聲心動圖(echocardiography)心導管及心血管造影(cardiaccatheterizationandcardioangiography)治療深低溫停循環(huán)室間隔缺損修補術體外循環(huán)室間隔缺損修補術5法魯氏四聯(lián)癥(TetralogyofFallot)病理解
6、剖特點(pathologicoanatomic)（圖5）血流動力學(hemodynamics)和臨床表現(xiàn)右向左分流杵狀指（趾）clubbedfinger(toe)紫紺(cyanosis)雜音(murmur)X線片(X-ray)心電圖(ECG)超聲心動圖(echocardiography)化驗檢查(laboratoryfindings)心導管及心血管造影(cardiaccatheterizationandcardioangiography)治療分流術深低溫停循環(huán)體外循環(huán)二、后天性心臟病Acquired
7、HeartDiseases（一）心包炎(pericarditis)1．急性化膿性心包炎(acutepurulentpericarditis)2．慢性縮窄性心包炎(chronicconstrictivepericarditis)（二）風濕性心臟病1．風濕性二尖瓣狹窄(rheumaticmitralstenosis)2．風濕性二尖瓣關閉不全(rheumaticmitralinsufficiency)3．主動脈瓣狹窄(aorticstenosis)4．主動脈瓣關閉不全(aorticinsufficienc
8、y)5．聯(lián)合瓣膜病6．三尖瓣病變(tricuspiddiseases)（三）冠狀動脈硬化性心臟病(CoronaryHeartDisease)1．左主干狹窄≥50%2．三支以上血管明顯狹窄≥70%3．單支以上還有前降支嚴重狹窄≥90%4．心肌梗死后并發(fā)癥(complicationsofmyocardialinfarction)⑴室間隔穿孔(perforationofinterventricularseptum)⑵乳頭肌、腱索斷裂(ruptureofpapillarymu
