1、Interventional Cardiac Catheterization Combined with Cardiac Surgery for Complex Congenital Heart DiseaseZhiwei Zhang,MD(张智伟)Guangdong Provincial Cardiovascular Institute The combined approach:A joint procedure involving intervention and surgery Staged therapy for complex disease Proven clinical eff
2、ectiveness and safety Some procedures even become the standard treatment for specific congenital heart disease Transcatheter intervention before surgery Intraoperative transcatheter intervention (Hybrid approach)Transcatheter intervention after surgeryTranscatheter Intervention before surgery Transc
3、atheter atrial septostomy Aortopulmonary collateral arteries occlusion Aortopulmonary shunt occlusion Radiofrequency or Laser-assisted pulmonary valvotomy and balloon valvuloplastyTranscatheter atrial septostomy TGA/IVS HLHS、MA HRHS、TA PA/IVS TAPVCBASAtrial septostomy in a fetus with HLHS RALAAortop
4、ulmonary collateral arteries occlusion before operation Occlusion of collaterals in a TOF case with RVOT reconstruction and 2 days later the case underwent surgical total correction Radiofrequency or Laser-assisted pulmonary valvotomy and balloon valvuloplasty PA/IVS Early establishment of continuit
5、y between the right ventricle with pulmonary trunk Decompressive the hypertensive right ventricle Promote growth of right ventricle As alternative to surgical treatment Effective in establishing RV-PA continuity Much lower immediate mortality and morbidity Improved outcome Radiofrequency or Laser-as
6、sisted pulmonary valvotomy and balloon valvuloplasty 图片 电影Intraoperative transcatheter interventionlIntraoperative stenting of pulmonary arteries or veinslVentricular device closure of muscular ventricular septal defectslPercutaneous approach to completion of total cavopulmonary connection or the Fo
7、ntan circuitlHybrid approach in the treatment of hypoplastic left heart syndromeIntraoperative Stenting of Branch Pulmonary ArteriesLimitations of Stent Implantation in Catheterization Laboratory1.Large delivery sheaths 2.Limited vascular access3.Small size of patients4.Concommitant surgical procedu
8、re requiredChest X-rayafter procedureHjortdal VE,European Journal of Cardio-thoracic Surgery 22,885890With the patient on cardiopulmonary bypass,a stent was implanted in the stenotic left pulmonary artery under direct vision.Hybrid Approaches To HLHS 请俊杰根据原文补充 Balloon Angioplasty or endovascular ste
9、nts for residue vessel stenosis Occlusion of duct after Fontan procedure Occlusion of residue ventricular septal defect Valve stent implantationInterventional techniques after surgery B-T conduit stenosis Stent implantationBalloon angioplasty for residue stenosis of LPA and RPA Stent implanting for
10、LPA stenosisVSD occlusion in a patient after palliative Switch procedure.Valve stent implanting Bonhoeffer P,et al.J Am Coll Cardiol.2002;39:16641669lInterventional catheterization has become an important treatment modalities for complex congenital heart disease.lThe combined approach plays an impor
11、tant role in the management strategies of complex congenital heart disease.Mortality,morbidity can be decreased and outcomes can be improved.lThe combined approach further increase the collaboration between cardiac surgeons and paediatric cardiologist in providing an effective,safe and efficient kind of treatment to patients with complex congenital heart disease.That are difficult,if not impossible,to be treated by surgery or interventional catheterization alone.lThe combined approach plays an increasing role in management of heart disease in children in the years ahead.THANKS
