Hiệu quả của kỹ thuật chọc vách liên nhĩ cải tiến trong thủ thuật nong van hai lá bằng bóng qua da

46 118 0
Hiệu quả của kỹ thuật chọc vách liên nhĩ cải tiến trong thủ thuật nong van hai lá bằng bóng qua da

Đang tải... (xem toàn văn)

Tài liệu hạn chế xem trước, để xem đầy đủ mời bạn chọn Tải xuống

Thông tin tài liệu

Efficacy of modified Technique for atrial Septal Puncture in Percutaneous Transvenous Mitral Commissurotomy Volume of PTMC at VNHI 705 610 560 553 491 523 495 509 504 510 327 6240 procedures in 2010 1419 PTCA, 510 PTMC, 458 CSI, 1165 EPS/PPM 143 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 BACKGROUND • Mitral Stenosis is still a big burden especially in developing country • The simplest technique (1st choice) for PTMC: Using Inoue Balloon • Effective: valid alternative to surgical therapy in selected patients  Septal Puncture: Vital Step, not only to avoid tamponade but also made an appropriate septal site to facilitate balloon crossing valve • At VNHI: Septal Puncture using modified technique since 2005 Landmark for Septal Punture Frontal Lateral Classic Septal Puncture Inoue J.S Hung Classic Septal Puncture (Ultrasound guided) Gupta Simplified Septal Puncture without Atery Access: - Puncture site must inside LA border - Landmark only base on LA • • • • No artery access New Landmark: # sign Clarify Left Atrium (PA angiography if needed) Catheter/Needle manipulation Catheter/needle fitting exercise Catheter/Needle Manipulation Simplified Technique “# technique” Septal Puncture result Septal Puncture 65 108 Favourable Difficult and fail Septal Puncture: Technical aspects (regression multifactor analysis) Group (Favourable) Group (Difficult and fail) OR P (n=108) LA diameter (Transthoracic 44,09  4,50 (n=65) 1,51 50,69 4,54 ultrasound) ≤ 100 Operator (95%CI) (1,32-1,73) < 0,001 1,20 50 28 (0,51-2,87) experiences 1,76 (number of 101 - 200 28 > 0,05 23 (0,70-4,46) cases) > 200 Age 30 14 45,6 ± 12,36 47,97±11,13 1,02 (0,99-1,04) Sex Male 19 16 Female 89 49 MVA before procedure 1,02 ± 0,81 0,93 ± 0,18 1,53 > 0,05 (0,72-3,24) 0,59 (0,16-2,15) Septal Puncture: Technical aspects Group Group (Favourable) (Difficult) (n=33) LA diameter (Angio) Enlarged RA (Angio) Normal Cardiothoraci ratio Enlarged 86,52 8,02 (n=28) 95,34 10,17 30,82  7,90 37,63 6,07 22 11 20 OR (95%CI) 1,11 (1,04-1,19) 1,15 (1,05-1,25) (1,67-14,92) P 0,002 0,002 < 0.01 Septal puncture in Pt with history of PTMC or surgery compared to 1st time PTMC PTMC or Surgery history Septal Puncture 1st time of PTMC Favourable 16 92 Difficult 11 51 Fail 27 146 (n=173) P > 0,05 Operator Experience Septal Puncture Favourable Difficult Fail P Operator ≤ 100 experience 101- (Number of 200 cases) > 200 Total n % n % n % 50 64,10 25 32,05 3,85 28 54,90 23 45,10 0 30 68,18 14 31,82 0 108 62,42 62 35,84 1,74 >0,05 173 CONCLUSION Modified technique for Septal Puncture (# technique) : High technical success rate: 98,27%  Decrease procedure time 32,77 ± 13,13(mins), decrease radiation exposure time 10,97 ± 10,96(mins)  PTMC result using this technique (PAP, LA pressure, MVA…), days of inpatients after PTMC comparable to classic technique  Only one venous access  CONCLUSION Some clinical aspects when using this technique: Enlarged LA and RA diameter: more difficult for Septal Puncture Age, sex, MVA, history of PTMC or surgery of patients have no affection on result of Septal Puncture  Experience operator (>100 cases) Thank you for your attention! Septal puncture: Tips and Tricks Always Clarify LA border Good catheter/needle manipulation Avoid puncture RA, Ao, Tricuspid valve and coronary sinus: inside LA border, # sign landmark, at – o’clock Needle tip reshaping Confirmation of LA entry before advance sheath to LA Crossing Mitral Stenotic Valve Methods: Vertical method Direct method Sliding method Alternative Loop method Individually Padial echo score Padial LR, Abascal VM, Palacios IF Am J Cardiol 1999; 83:1210-1213 Predictor of severe MR after PTMC Our experience Parameters RR Age 0.85 (0.28 ... times Research Parameter Procedure time (mins) Radiation exposure time (mins) Day of inpatient after PTMC (days) Procedure result : Technical success and no complocation Complication: Death,... 1.73% Success Fail 98.27% Nguyễn Quang Tuấn: (n=220) 96% Jui Sung Hung: (n=219) 97% Võ Thành Nhân: (n=147) 99,3% Procedure time, radiation exposure time and days of inpatient after procedure

Ngày đăng: 05/12/2017, 00:20

Từ khóa liên quan

Tài liệu cùng người dùng

Tài liệu liên quan