Catheterization

Cha pt er1 3 Th e Catheterization Therapy of Cardiovascular Disea ses Jiaqi Zhao

Department of Cardiology, Affiliated Hospital of Ji ning Medical College, Ji ning

Pa rt 1 Th e C atheterization Therapy of Con ge nit al H ear t

Dise as es

Interventional therapy of ASD ： 

●1998

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主 动 脉 侧 缘

●

后 壁 缘

Procedure （一）

balloon ASD How to measure diameter of ASD

Procedure （二）

Procedure （三）

After plantation from selected cineradiogram

Amplatzer

Cardioseal

Amplatzerdouble-diskiform closer

Interventional therapy of VSD

●

世 界 首 例

囊袋（ 囊袋 sac ） 形室缺

嵴内型室间隔缺损的封堵治疗

Interventional therapy of PDA

号 4-6 ， 6-8 ， 8-10 ， 10-12 ， 12-14 ， 14-16 ， 16-18

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Procedure （一 ） PDA

Procedure （二 ） 堵闭器放置 堵闭 器

Procedure （三） 降主动脉造影 Descending aortic angiography 证实堵闭器位 置及堵闭效果

术后造影

Pa rt 2 Th e C atheterization Therapy of Va lv ula r Hea rt

Dise as es

pulmonary valve stenosis

Visualization of predilation 扩张前造影

percutaneous balloon pulmonary valvuloplasty (PBPV)

Visualization of postdilation

coarctation of the aorta 主 A 缩窄球囊扩张术

经皮球囊二尖瓣成形术 Peercutaneous balloon mitrail valvuloplasty

(PBMV ）

Pa rt 3 Th e C atheterization Therapy of Coro na ry

Ath ero sc ler ot ic Dise as es

H ea rt

The Procedure

The Procedure

Hemostasis valve

Dilator

Introducer sheath is like a large IV which allows controlled access to the body. Dilator offers minimal trauma to the vessel. Hemostasis valve prevents excessive blood loss.

Judkins Right Pigtail

Judkins Left

Diagnostic catheter: a plastic tube which functions as a conduit for contrast, fluids, and pressure measurement during cardiac catheterization of coronary arteries and left ventricle.

6F Z2 Guide Catheter

Guide catheter: a larger lumen plastic tube which functions as a conduit for the wire and balloon for PTCA and/or stent implantation.

Angioplasty guide wire: a stainless steel wire with a small outer diameter (.010 –.018”)that is used to negotiate the coronary vasculature to reach and cross a lesion, then support the balloon catheter during advancement across the lesion.

Balloon catheter: a small diameter hollow tube with a second smaller tube attached to material at the base of the catheter (balloon). The balloon is inflated via the smaller tube, the inflation lumen, once it is placed across the lesion.

Inflation device: used for controlled inflation of the balloon.

Coronary Arteries

Left Coronary Ostia Right Coronary Ostia

Aortic Valve Cusps

The Procedure

The Coronary Arteries

Disease Process

Normal Coronary Artery

Copyright 1989. Novartis. Reprinted with permission from the Atlas of Human Anatomy, illustrated by Frank H. Netter, M.D. All rights reserved.

Treatment alternatives PTCA

PTCA Procedure

Pre-PTCA: Guidewire in Lesion During PTCA: Balloon Inflated Post-PTCA: Balloon Deflated

• Coronary stent: a metal tube, coil or continuously connected element formed as a cylinder which is designed to keep the dilated artery open.

Wire Mesh Stent Wire Coil Stents Schneider Self-Expanding Wallstent

Tubular Slotted Stents

Cook GR II Medtronic Wiktor

Modular Stents ACS/Guidant Multi-Link

Scimed/Boston Scientific NIR

J&J Palmaz-Schatz

AVE GFX 2

Stent Placement

Stent Delivery and Expansion

Par t 4 Radiofrequency Current Catheter Ablation (RFC A)

cs HRA HRA

HIS H

RVA

方法 method

第四节

埋藏式心律转复除颤器

Part 4 Implantable Cardioverter Defibrillator • single

chamber

• dual chamber • CRTD

Advancement of ICD

Dual chamber ICD

心房和 心室 心室  抗心动 过速起搏  同步电 复律  电击除 颤

 心动过 缓感知  心动过 缓起搏

Part 5 Artificial A Cardiac pacing

人工心脏起搏器 Pacemaker

 适应症

Which are the indications

for permanent pacing ？

standardized nomenclature  AAI

VVI DDD DDDR(DR)  The first letter refers to the chamber that is stimulated.  The secon letter refers to the chamber in which sensing occurs.  The third position refers to the sensory mode . I :inhibition, T :triggering,  The fourth letter refers to the programmability :R:response ,For rate modulation.

 Approach

：头静脉 cephalic vein ；  锁骨下静脉 subclavian vein  auricular electrode ： right auricular appendage  ventricular electrode ： Apex of heart  coronary venous sinus electrodes ： great cardiac veins

Cardiac Resynchronization Therapy （心脏 再同 步治疗 ）

Right Atrial Lead Coronary Sinus Lead

Right Ventricular Lead

method

CRT For CHF

手术过程只需 1 小时！ 局部麻醉 local anaesthesia  静脉入路置放电极导 线 

– 从头静脉 / 锁骨下静脉

穿刺插入导管 – 将电极送入心腔 – 被动或主动固定电极 – 测试电极性能 

皮下植入起搏器 – 制作起搏器囊袋

程控仪器 program control equipment; 、临时起 搏器 temporary pacemaker;TPM 和分析仪 analysator

5318 临时起搏器和分析仪 9790 程控仪

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