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    The traps and prevention in the interventional treatment of congenital heart disease

    Home >> >> The traps and prevention in the interventional treatment of congenital heart disease
    The traps and prevention in the interventional treatment of congenital heart disease
    1 The complete basic facilities of the catheterization room is the basic guarantee for interventional treatment of congenital heart disease
    1.1 Catheter Room Required Equipment and Instruments: Cardiovascular Angiography Machine; Image Recovery and Recording System; Ventilator Anesthesia Machine; Vacuum Suction Aspirator; Defibrillator; ECG Monitor; Invasive Pressure Detector; High Pressure Syringe; Various Commonly used and rescue drugs
    1.2 Note: Pediatric anesthesia; Breathless; Forbidden to drink fasting; Postoperative anesthesia, postoperative care
    2 Common pitfalls and prevention in congenital heart disease intervention
    2.1 traps and prevention of interventional treatment of atrial septal defect
    2.1.1 Inadequacy of indication selection:
    2.1.1.1 possible malformations and prevention: TAPVC; PAPV; TGA, TVa, PAA + IVS; left heart dysplasia; other. In the above-mentioned malformations, ASD is often the "lifeline" that depends on survival. If it is closed, it can cause death (even death on the spot).
    2.1.1.2 Merge primary pulmonary hypertension, the effect of intervention or surgery is not obvious, or even harmful.
    2.1.1.3 Eisenmenger Syndrome, Pulmonary Arterial Hypertension, Pulmonary Arterial Hypertension After Plugging Does Not Decrease or Even Increased, Can Aggravate the Condition and Cause Sudden Death.
    2.1.2 Countermeasures: Understand the history and signs; familiar with the X-ray and UGG diagnosis; compare the differences between imaging diagnosis and clinical manifestations; pay attention to the manifestations and signs of various contradictions and analyze the possible concurrency of the census. Malformation and unfavorable factors.
    2.1.3 Common pitfalls and complications in interventions for atrial fibrillation
    2.1.3.1 Delayed pericardial tamponade: The guidewire and/or catheter pierce the atrial (ear) wall. Pushing the guidewire at the tip of the catheter at the top of the housing wall or atrial appendage can easily result in perforation of the atrial (ear) wall. Should try to avoid or reduce this operation during surgery. Postoperatively, if the patient has discomfort, palpitations or even irritability, it should be thought that late pericardial effusion may be possible, and timely investigation (UGG, etc.) can avoid serious complications.
    2.1.3.2 Acute pericardial tamponade: Delivery sheath injury breaks the wall or atrial appendage, which may occur when a sheath is used to deliver directly from the right to the left atrium. Under normal circumstances, the advance of the delivery sheath must be guided by the guide wire. When it is used alone, it must be handled with extreme caution. In case of resistance, it must not be forcibly pushed. The direction of the sheath tip should be adjusted before trying again.
    2.1.3.3 Endocardial or chorda tendon injury: Often caused by the rotation and pushing of occluders or push rods. Releasing the occluder is to operate the cable within the sheath as much as possible, using special techniques such as the "pulmonary vein" method. Excessive operation can cause damage to the intima of the pulmonary veins and atrial wall.
    2.1.3.4 occluder detachment: Most indications are caused by inappropriate indications, and most of them are related to insufficient or thin edge of inferior vena cava; secondly, occluder selection is too small, and the reason is preoperative diagnosis. (mainly UGG) underestimate the size of ASD; due to improper operation, as long as the occluder is loose or tightly installed, intentionally or unintentionally, the push rod is caused by internal rotation; in addition, the position of the occluder is misaligned. Lack of edges can also cause the occluder to come off.
    2.1.3.5 Coronary or cerebrovascular gas embolism or thromboembolism: delivery sheath hemostasis valve and push rod are not closed tightly or the operator is not fully vented during operation. In severe cases, ST-segment elevation, angina, and chambers may occur. Tremor, and complications such as Aspen syndrome or cerebral embolism, hemiplegia. Regulatory procedures to prevent gas from entering the sheath and proper heparinization can reduce or avoid its occurrence.
    2.1.3.6 ASDO blocks PV and CS, causing their backflow to be blocked. Intraoperative ultrasound is the key to avoid this complication.
    2.1.4 Traps and prevention of complications in interventions for atrial fissures
    2.1.4.1 Familiar with ASD anatomy and pathophysiological processes, mastering their clinical manifestations and characteristics are the basic conditions for surgeons to prevent various traps.
    2.1.4.2 Specification Operation
    2.1.4.3 Pay attention to the collection of preoperative clinical signs and symptoms of patients and comparison and diagnosis of various examinations. Emphasis on the main complaints, symptoms, and appeals of patients during and after surgery is an important clue to avoid the occurrence of preventers and remedy. If there are various symptoms or inconsistencies should be actively investigated in a timely manner to find the cause, in order to prevent falling into the trap to avoid the development of various complications.
    2.1.4.4 In the event that the guide wire or catheter fails to deliver the left pulmonary vein repeatedly, or if the increase in pulmonary hypertension is not consistent with the size of the defect, caution should be exercised if PAPVC or even TAPVC is incorporated. Ultrasound can be further checked and angiography can be performed if necessary.
    2.1.4.5 In the treatment of ASD, UGG is very important both before and after surgery and after surgery. A good sonographer will benefit from atrial fibrillation intervention.
    2.1.4.6 Care should be taken in the case of poor ASD edge conditions, and TEE inspection is necessary at this time.
    2.1.4.7 The application of the new ASD measurer will greatly increase the success rate of interventions for atrial septum and reduce the dependence on surgeons' advanced imaging equipment.
    2.2 Traps and Prevention in Interventional Treatment of Ventricular Septal Defects
    2.2.1 Choice of Indications
    2.2.1.1 Determine the relationship between the size, shape and location of ventricular lacunae and adjacent structures: if it affects the aortic valve, tricuspid valve, etc.
    2.2.1.2 Clarify whether or not there is a malformation.
    2.2.1.3 Combining primary concurrent pulmonary hypertension or Eisenmenger syndrome
    2.2.2 Effect of the instrument: When disassembling the bolt, the bolt is rotated against the inner structure in the counter-rotation; the tricuspid valve chordae are passed through when the track is established; the sheath tube is discounted; the rotating sheath or push rod is screwed to the intracardiac structure.
    2.2.3 Complications and Prevention in Ventricular Intervention: Arrhythmia; Occluder Displacement; Residual Shunt--Hemolysis; Aortic Insufficiency; Tricuspid Regurgitation; Vascular Myocardial Damage; Live tricuspid valve, chordola
    2.3 Traps and prevention in the interventional treatment of patent ductus arteriosus
    2.3.1 Identification of Eisenmenger Syndrome: Blood gas analysis - Upper limb blood oxygen saturation; false double period noise; no noise is not completely reliable
    2.3.2 Differential diagnosis and malformation: APSD, VSD, Sub-AS and IAA; RPA origin abnormalities; coA hypertension
    2.3.3 Difficulties with catheters entering the PDA to the descending aorta: PDA flexing; PDA floating, PDA small. Countermeasures: direct guide wire guide; arterial approach marking, straightening; catcher (A, V end arrest); direct arterial embolization, plugging.
    2.3.4 complications and its treatment: residual shunt, hemolysis; aortic, left pulmonary artery obstruction (common in infants and young children, early imaging observation); occluder off. Countermeasures: Select the appropriate occluder, add fillers, measuring devices, custom-made.
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