左心耳封堵术病例集

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左心耳封堵术病例集

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左心耳封堵术病例集

左心耳封堵术病例集

$71.68

编辑推荐

近年来我国心血管相关疾病发病人数持续增加,心房颤动作为一种常见的心血管疾病,是导致脑卒中发生的重要原因之一。房颤导致的脑卒中致残、致死率高,且易复发,因此有效预防是降低患者卒中风险、有益于社会和家庭的重要措施。左心耳封堵术是不适合长期口服抗凝药物的房颤患者预防卒中的新技术。《左心耳封堵术病例集》汇集了2022年全国左心耳封堵术病例比赛中的获奖病例,展现了整体的诊疗流程,并归纳总结了病例中的要点、难点。本书的出版可供想要开展或...

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编辑推荐

近年来我国心血管相关疾病发病人数持续增加,心房颤动作为一种常见的心血管疾病,是导致脑卒中发生的重要原因之一。房颤导致的脑卒中致残、致死率高,且易复发,因此有效预防是降低患者卒中风险、有益于社会和家庭的重要措施。左心耳封堵术是不适合长期口服抗凝药物的房颤患者预防卒中的新技术。《左心耳封堵术病例集》汇集了2022年全国左心耳封堵术病例比赛中的获奖病例,展现了整体的诊疗流程,并归纳总结了病例中的要点、难点。本书的出版可供想要开展或正在应用左心耳封堵术的临床工作者学习和参考。

 
内容简介

本书汇集了2022年全国左心耳封堵术病例比赛中的获奖病例,在简要介绍病史资料的基础上,全面展现了从术前检查、诊断和评估,到治疗方案制订、封堵策略分析,再到手术过程和术后随访的完整流程,并通过专家点评从更高的视角分析不同病例中手术的难点和要点,以帮助广大读者研究病例背后的优化策略。
本书图文并重、语言简练,以30个精彩病例重点展示了左心耳封堵术的手术步骤和手术操作过程中的技巧、难点,可供开展左心耳封堵术的临床医师学习和参考。

作者简介

主编 周达新:医学博士,主任医师,博士生导师。复旦大学附属中山医院心内科副主任,心脏介入中心副主任;上海市心血管病研究所心内科行政副主任。在国内率先开展经导管主动脉瓣置换术、经导管肺动脉瓣置换术、经导管二尖瓣反流修复术,和经皮主动脉瓣瓣周瘘、二尖瓣瓣周瘘介入治疗术,以及率先开展经导管三尖瓣环成型术、经导管三尖瓣置换术、先天性心脏病室间隔缺损介入治疗,在先天性心脏病房间隔缺损、动脉导管未闭、主动脉瓣周瘘,特别是大房缺的介入治疗方面处于领先地位。以作者名义发表论文近60余篇论文,被SCI收录16篇,EM收录1篇;曾主编《结构性心脏病介入诊疗病例解析》《经导管心脏瓣膜治疗术》。

目  录

病例 1 · “微操不惧,熟稔于心”:裤衩型早分叶左心耳WATCHMAN封堵 / 001

 复旦大学附属中山医院 周达新 张 蕾

病例 2 · MitraClip联合LAAC一站式治疗 / 014

 珠海市人民医院 姜小飞 袁 圆

病例 3 · “守望者之吻”:KISSING WATCHMAN / 023

 宁波市医院 储慧民 杜先锋

病例 4 · 反鸡翅型左心耳封堵的不对称调整 / 033

 天津医科大学总医院 蔡 衡 李洪仕

病例 5 · 低位敞口反鸡翅型左心耳封堵 / 041

 贵州医科大学附属医院 周 纬 谌晶晶

病例 6 · 大开口敞口浅左心耳封堵 / 049

 江苏省人民医院 陈明龙 刘海雷

病例 7 · 食管癌术后ICE指导下的单纯左心耳封堵 / 055

 上海交通大学医学院附属第九人民医院 张俊峰 张宗棨

病例 8 · 低位反鸡翅型左心耳封堵 / 064

 新疆医科大学附属医院 周贤惠 郭衍楷

病例 9 · 中间分叶大折角鸡翅型左心耳封堵 / 072

 柳州市工人医院 何柳平

病例10 · 超大浅左心耳封堵 / 081

 楚雄州人民医院 胡永平


病例11 · 未完待续的房颤卒中预防之路 / 087

 海军军医大学附属医院 黄松群

病例12 · 大囊袋菜花型左心耳封堵 / 095

 上海市第六人民医院 李京波 金 贤

病例13 · 持续房颤射频消融 左心耳封堵一站式手术 / 104

 香港大学深圳医院 李海瑞

病例14 · 高难度鸡翅型浅左心耳封堵 / 110

 梅州市人民医院 钟 炜 李友钱

病例15 · 上下缘极其不对称的仙人掌型左心耳封堵 / 118

 汕头大学医学院第二附属医院 李吉林 林伟昭

病例16 · 反鸡翅型浅左心耳封堵 / 125

 海军军医大学第二附属医院 汤晔华

病例17 · 房间隔穿刺困难的左心耳封堵 / 130

 首都医科大学附属北京友谊医院 陈 淼

病例18 · 复杂分叶左心耳封堵器自适应封堵 / 135

 苏州大学附属医院 邹 操 徐明珠

病例19 · 菜花型左心耳封堵 / 144

 上海中医药大学附属普陀区中心医院 杨 伟

病例20 · 极浅蘑菇型左心耳封堵 / 148

 新疆医科大学附属医院 李耀东 杨 徐 

病例21 · XR–STAR术式下房颤消融联合浅左心耳封堵 / 152

 河北医科大学第二医院 谢瑞芹 张亚楠

病例22 · “大肚子”左心耳封堵 / 159

 厦门大学附属心血管病医院 周法光

病例23 · 影像的骗局 / 166

 中国科学院大学宁波华美医院 江隆福 吴 昊

病例24 · “蹊径轻取妖耳”:非共面早分叶型左心耳封堵 / 173

 上海交通大学医学院附属瑞金医院 丁风华 朱劲舟 


病例25 · 高难度低位敞口反鸡翅型浅左心耳封堵 / 182

 天门市人民医院 尹 琼 夏旭辉

病例26 · 大开口大转角鸡翅型左心耳封堵 / 189

 中南大学湘雅医院 谢启应 赵伊遐

病例27 · 大开口菜花型左心耳封堵 / 194

 株洲市人民医院 曾维理 凌 娟

病例28 · 心动不如行动,行动一定早动 / 200

 湖南省人民医院 潘宏伟 胡 遵

病例29 · 千佛手型左心耳封堵 / 207

 山西省心血管病医院 李小明 马 英

病例30 · 一波三折的“一站式” / 214

 山东医科大学附属医院 闫素华 王 晔

前  言

百舸争流千帆竞,乘风破浪正当时

根据2022年4月《柳叶刀》子刊发布的文章,一项中国房颤患者全国横断流行病学研究发现,年龄标准化后的房颤总体患病率为1.6%~1.7%,即中国有2 000万例以上的房颤患者。房颤会引起卒中、动脉栓塞性疾病,因此,中国房颤患者的管理任重而道远。

EuroIntervention真实世界大样本研究提示:房颤、房扑患者,尤其是做过肺静脉隔离的患者,其心源性血栓100%来自左心耳。左心耳封堵术(LAAC)通过封堵左心耳预防左心耳内血栓引起的血管栓塞,从而避免卒中的发生。2019年欧洲心脏病学会(ESC)大会上公布的首个小样本随机化PRAGU—17研究3年随访结果揭晓:左心耳封堵术对比新型口服抗凝药(NOAC),在心血管死亡、卒中或短暂性脑缺血发作(transient ischemic attack,TIA)事件发生率方面具有非劣性,在非临床相关出血性事件方面,LAAC组的发生率不仅低于NOAC组,且具有统计学差异(3.4% vs 5.9%,HR = 0.55,P = 0.038)。再一次展示出了LAAC这项技术能带给房颤患者的关键优势,提示LAAC可作为非瓣膜性房颤患者长期服用抗凝药物的非药物替代方案。

从2019年美国心脏病学会(ACC)房颤指南、欧洲经皮心血管介入学会(EAPCI)专家共识、ESC指南等来看,左心耳封堵术得到了国内外指南和临床的认可。2014年至2021年,相关指南中的推荐等级发生了较大改变。中华医学会心电生理和起搏分会、中国医师协会心律学专业委员会和中国房颤中心联盟心房颤动防治专家工作委员会发布的《心房颤动:目前的认识和治疗建议(2021)》中,提出了首个针对左心耳封堵术的Ⅰ类推荐:对于左心耳电隔离之后的房颤患者,可行左心耳封堵术预防血栓栓塞事件。同时也将常规左心耳封堵术适应证的证据级别从B级提升到了A级。中国医师协会心血管内科医师分会结构性心脏病专业委员会制订并于2022年发布了《简化式左心耳封堵术临床路径中国专家共识(2022)》,该共识凝结了国内诸多学者的丰富经验,是我国版简化式左心耳封堵术的专家共识,旨在优化术式,造福患者。

左心耳封堵术于2013年登陆中国,以波士顿科学为引领者,通过建立完整健全的培训、带教体系,培养了国内代左心耳封堵术者。随着国产器械并驱争先,近年来左心耳封堵术在中国高速发展。左心耳封堵术走过的8年风雨岁月里,从一开始被质疑,到逐渐得到信任,如今又走到了新的十字路口——如何更为规范化、同质化地推广与下沉疗法,并进一步提高手术安全性,为房颤患者带来更大临床获益。基于此,左心耳封堵术病例大赛应运而生,并已走过6个年头,每一届比赛都汇聚了全国青年术者,探讨左心耳封堵策略和技巧,旨在提高术者专业与技能水平。

本书汇集了2022年全国左心耳封堵术病例大赛中的优秀案例,全真展现了从术前检查,到策略制订、手术过程及术后随访的完整流程,并通过专家点评,不仅还原比赛的精彩过程,更是抛砖引玉,为广大读者研读病例背后的策略优化提供思路。

百舸争流千帆竞,乘风破浪正当时。期待广大青年术者能从本书中汲取经验与真知,并投入房颤综合管理与卒中预防的事业中,造福更多患者。

周达新
2022年9月

在线试读

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编辑推荐

近年来我国心血管相关疾病发病人数持续增加,心房颤动作为一种常见的心血管疾病,是导致脑卒中发生的重要原因之一。房颤导致的脑卒中致残、致死率高,且易复发,因此有效预防是降低患者卒中风险、有益于社会和家庭的重要措施。左心耳封堵术是不适合长期口服抗凝药物的房颤患者预防卒中的新技术。《左心耳封堵术病例集》汇集了2022年全国左心耳封堵术病例比赛中的获奖病例,展现了整体的诊疗流程,并归纳总结了病例中的要点、难点。本书的出版可供想要开展或正在应用左心耳封堵术的临床工作者学习和参考。

 
内容简介

本书汇集了2022年全国左心耳封堵术病例比赛中的获奖病例,在简要介绍病史资料的基础上,全面展现了从术前检查、诊断和评估,到治疗方案制订、封堵策略分析,再到手术过程和术后随访的完整流程,并通过专家点评从更高的视角分析不同病例中手术的难点和要点,以帮助广大读者研究病例背后的优化策略。
本书图文并重、语言简练,以30个精彩病例重点展示了左心耳封堵术的手术步骤和手术操作过程中的技巧、难点,可供开展左心耳封堵术的临床医师学习和参考。

作者简介

主编 周达新:医学博士,主任医师,博士生导师。复旦大学附属中山医院心内科副主任,心脏介入中心副主任;上海市心血管病研究所心内科行政副主任。在国内率先开展经导管主动脉瓣置换术、经导管肺动脉瓣置换术、经导管二尖瓣反流修复术,和经皮主动脉瓣瓣周瘘、二尖瓣瓣周瘘介入治疗术,以及率先开展经导管三尖瓣环成型术、经导管三尖瓣置换术、先天性心脏病室间隔缺损介入治疗,在先天性心脏病房间隔缺损、动脉导管未闭、主动脉瓣周瘘,特别是大房缺的介入治疗方面处于领先地位。以作者名义发表论文近60余篇论文,被SCI收录16篇,EM收录1篇;曾主编《结构性心脏病介入诊疗病例解析》《经导管心脏瓣膜治疗术》。

目  录

病例 1 · “微操不惧,熟稔于心”:裤衩型早分叶左心耳WATCHMAN封堵 / 001

 复旦大学附属中山医院 周达新 张 蕾

病例 2 · MitraClip联合LAAC一站式治疗 / 014

 珠海市人民医院 姜小飞 袁 圆

病例 3 · “守望者之吻”:KISSING WATCHMAN / 023

 宁波市医院 储慧民 杜先锋

病例 4 · 反鸡翅型左心耳封堵的不对称调整 / 033

 天津医科大学总医院 蔡 衡 李洪仕

病例 5 · 低位敞口反鸡翅型左心耳封堵 / 041

 贵州医科大学附属医院 周 纬 谌晶晶

病例 6 · 大开口敞口浅左心耳封堵 / 049

 江苏省人民医院 陈明龙 刘海雷

病例 7 · 食管癌术后ICE指导下的单纯左心耳封堵 / 055

 上海交通大学医学院附属第九人民医院 张俊峰 张宗棨

病例 8 · 低位反鸡翅型左心耳封堵 / 064

 新疆医科大学附属医院 周贤惠 郭衍楷

病例 9 · 中间分叶大折角鸡翅型左心耳封堵 / 072

 柳州市工人医院 何柳平

病例10 · 超大浅左心耳封堵 / 081

 楚雄州人民医院 胡永平


病例11 · 未完待续的房颤卒中预防之路 / 087

 海军军医大学附属医院 黄松群

病例12 · 大囊袋菜花型左心耳封堵 / 095

 上海市第六人民医院 李京波 金 贤

病例13 · 持续房颤射频消融 左心耳封堵一站式手术 / 104

 香港大学深圳医院 李海瑞

病例14 · 高难度鸡翅型浅左心耳封堵 / 110

 梅州市人民医院 钟 炜 李友钱

病例15 · 上下缘极其不对称的仙人掌型左心耳封堵 / 118

 汕头大学医学院第二附属医院 李吉林 林伟昭

病例16 · 反鸡翅型浅左心耳封堵 / 125

 海军军医大学第二附属医院 汤晔华

病例17 · 房间隔穿刺困难的左心耳封堵 / 130

 首都医科大学附属北京友谊医院 陈 淼

病例18 · 复杂分叶左心耳封堵器自适应封堵 / 135

 苏州大学附属医院 邹 操 徐明珠

病例19 · 菜花型左心耳封堵 / 144

 上海中医药大学附属普陀区中心医院 杨 伟

病例20 · 极浅蘑菇型左心耳封堵 / 148

 新疆医科大学附属医院 李耀东 杨 徐 

病例21 · XR–STAR术式下房颤消融联合浅左心耳封堵 / 152

 河北医科大学第二医院 谢瑞芹 张亚楠

病例22 · “大肚子”左心耳封堵 / 159

 厦门大学附属心血管病医院 周法光

病例23 · 影像的骗局 / 166

 中国科学院大学宁波华美医院 江隆福 吴 昊

病例24 · “蹊径轻取妖耳”:非共面早分叶型左心耳封堵 / 173

 上海交通大学医学院附属瑞金医院 丁风华 朱劲舟 


病例25 · 高难度低位敞口反鸡翅型浅左心耳封堵 / 182

 天门市人民医院 尹 琼 夏旭辉

病例26 · 大开口大转角鸡翅型左心耳封堵 / 189

 中南大学湘雅医院 谢启应 赵伊遐

病例27 · 大开口菜花型左心耳封堵 / 194

 株洲市人民医院 曾维理 凌 娟

病例28 · 心动不如行动,行动一定早动 / 200

 湖南省人民医院 潘宏伟 胡 遵

病例29 · 千佛手型左心耳封堵 / 207

 山西省心血管病医院 李小明 马 英

病例30 · 一波三折的“一站式” / 214

 山东医科大学附属医院 闫素华 王 晔

前  言

百舸争流千帆竞,乘风破浪正当时

根据2022年4月《柳叶刀》子刊发布的文章,一项中国房颤患者全国横断流行病学研究发现,年龄标准化后的房颤总体患病率为1.6%~1.7%,即中国有2 000万例以上的房颤患者。房颤会引起卒中、动脉栓塞性疾病,因此,中国房颤患者的管理任重而道远。

EuroIntervention真实世界大样本研究提示:房颤、房扑患者,尤其是做过肺静脉隔离的患者,其心源性血栓100%来自左心耳。左心耳封堵术(LAAC)通过封堵左心耳预防左心耳内血栓引起的血管栓塞,从而避免卒中的发生。2019年欧洲心脏病学会(ESC)大会上公布的首个小样本随机化PRAGU—17研究3年随访结果揭晓:左心耳封堵术对比新型口服抗凝药(NOAC),在心血管死亡、卒中或短暂性脑缺血发作(transient ischemic attack,TIA)事件发生率方面具有非劣性,在非临床相关出血性事件方面,LAAC组的发生率不仅低于NOAC组,且具有统计学差异(3.4% vs 5.9%,HR = 0.55,P = 0.038)。再一次展示出了LAAC这项技术能带给房颤患者的关键优势,提示LAAC可作为非瓣膜性房颤患者长期服用抗凝药物的非药物替代方案。

从2019年美国心脏病学会(ACC)房颤指南、欧洲经皮心血管介入学会(EAPCI)专家共识、ESC指南等来看,左心耳封堵术得到了国内外指南和临床的认可。2014年至2021年,相关指南中的推荐等级发生了较大改变。中华医学会心电生理和起搏分会、中国医师协会心律学专业委员会和中国房颤中心联盟心房颤动防治专家工作委员会发布的《心房颤动:目前的认识和治疗建议(2021)》中,提出了首个针对左心耳封堵术的Ⅰ类推荐:对于左心耳电隔离之后的房颤患者,可行左心耳封堵术预防血栓栓塞事件。同时也将常规左心耳封堵术适应证的证据级别从B级提升到了A级。中国医师协会心血管内科医师分会结构性心脏病专业委员会制订并于2022年发布了《简化式左心耳封堵术临床路径中国专家共识(2022)》,该共识凝结了国内诸多学者的丰富经验,是我国版简化式左心耳封堵术的专家共识,旨在优化术式,造福患者。

左心耳封堵术于2013年登陆中国,以波士顿科学为引领者,通过建立完整健全的培训、带教体系,培养了国内代左心耳封堵术者。随着国产器械并驱争先,近年来左心耳封堵术在中国高速发展。左心耳封堵术走过的8年风雨岁月里,从一开始被质疑,到逐渐得到信任,如今又走到了新的十字路口——如何更为规范化、同质化地推广与下沉疗法,并进一步提高手术安全性,为房颤患者带来更大临床获益。基于此,左心耳封堵术病例大赛应运而生,并已走过6个年头,每一届比赛都汇聚了全国青年术者,探讨左心耳封堵策略和技巧,旨在提高术者专业与技能水平。

本书汇集了2022年全国左心耳封堵术病例大赛中的优秀案例,全真展现了从术前检查,到策略制订、手术过程及术后随访的完整流程,并通过专家点评,不仅还原比赛的精彩过程,更是抛砖引玉,为广大读者研读病例背后的策略优化提供思路。

百舸争流千帆竞,乘风破浪正当时。期待广大青年术者能从本书中汲取经验与真知,并投入房颤综合管理与卒中预防的事业中,造福更多患者。

周达新
2022年9月

在线试读

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