【一站式Case Report】丨周达新教授:脉冲消融联合小浅左心耳封堵挑战病例



手术策略



先行FARAPULSE脉冲消融术进行症状管理,再行WATCHMAN FLX心耳封堵进行卒中预防。




病例要点



1. 术前TEE与CTA三维重建可以很好的帮助了解心耳信息,提前制定手术策略,做到心中有数。


2. 对于开口较小的心耳,选择封堵器需更为谨慎,操作当更加小心,实时留意病人变化。


3. 房间隔穿刺时,考虑到联合PFA一站式,且心耳位置处高位,需上下偏中间,前后偏中间,好的穿刺是成功的一半


4. 关键时刻,使用毛毛虫展开法,可以更好地调整封堵器轴向,并更加充分地利用心耳可用深度。


5. WATCHMAN FLX因其更加直观的三种展开形态,可以更加容易地观察其形态,进行术中PASS原则的评估


6. 术后使用左心耳增强CT可以更为直观地了解病人心耳内皮化结果,确保术后随访PASS,达到手术终点。




完整病例视频





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术者:周达新

Physician: Zhou Daxin


复旦大学附属中山医院心内科副主任,导管室副主任,结构性心脏病、肺动脉高压专科主任,博士研究生导师。


中华医学会心血管病专委会委员,中国医师协会心血管病分会结构性心脏病专委会副主任委员、中华医学会心电生理分会左心耳封堵工作委员会副主任委员、上海市心血管病学会结构性心脏病学组副组长、东方心脏病学大会结构论坛坛主、中国医师学会肺动脉高压规范化治疗基地主任、卫计委先天性心脏病介入治疗培训基地主任、长三角心源性卒中防治专委会主任委员、《中国临床药学杂志》常务编委、《中国介入心脏病学杂志》编委、《中华心血管病杂志》网络版编委、《上海医药杂志》编委


起草《导管主动脉瓣置换专家共识》、《经导管主动脉瓣置换团队建设》、《中国左心耳封堵治疗临床路径》专家共识,参加制订中国结构心脏病诊疗指南,起草房间隔介入治疗专家共识,参加制定中国肺动脉高压诊疗指南,参加制定中国先天心脏病合并重度肺动脉高压治疗专家共识。卫计委心血管病介入治疗考试命题专家。


《结构性心脏病介入诊疗病例解析》、《经导管心脏瓣膜治疗术》、《肺动脉高压治疗学》主编,《疑难先天性心脏病介入治疗与图解》副主编。


以第一完成人获得上海市科委课题3项,其中重点课题一项。


《产学研》课题三项,获得专利10项,其中发明专利2项,事项专利转化3项。


在国内、外期刊专业刊物上以第一作者名义发表论文近400余篇论文,被SCI收录近60余篇。


2014年以第一完成人获得上海市科技进步三等奖。


2021荣获教育部科技进步一等奖。


• Deputy Director of the Department of Cardiology and Deputy Director of the Catheterization Laboratory at Zhongshan Hospital, Fudan University; Director of the Structural Heart Disease and Pulmonary Hypertension Program; Doctoral Supervisor.


• Member of the Cardiovascular Disease Committee and Vice Chair of the Left Atrial Appendage Occlusion Working Committee of the Chinese Society of Pacing and Electrophysiology, Chinese Medical Association; Vice Chair of the Structural Heart Disease Committee of the Chinese Society of Cardiovascular Diseases and Director of the Standardized Treatment Center for Pulmonary Hypertension, Chinese Medical Doctor Association; Deputy Leader of the Structural Heart Disease Group of the Shanghai Society of Cardiovascular Diseases; Chair of the Structural Heart Disease Forum of the Oriental Congress of Cardiology; Director of the Training Base for Interventional Therapy of Congenital Heart Disease, National Health Commision of China; Chair of the Yangtze River Delta Committee for the Prevention and Treatment of Cardioembolic Stroke. 


• Executive Editorial Board Member of the Chinese Journal of Clinical Pharmacy; and Editorial Board Member of the Chinese Journal of Interventional Cardiology, Chinese Journal of Cardiology (online edition), and Shanghai Medical & Pharmaceutical Journal


• Participated in drafting the “Expert Consensus on Transcatheter Aortic Valve Replacement,” “Team Development for Transcatheter Aortic Valve Replacement,” and the “China Clinical Pathway for Left Atrial Appendage Closure”;  as well as the Chinese Guidelines for the Diagnosis and Treatment of Structural Heart Disease; the Expert Consensus on Interventional Treatment of Atrial Septal Defects; Chinese Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension, and the Expert Consensus on the Management of Congenital Heart Disease with Severe Pulmonary Hypertension. N


• Serves as an question development expert for the Cardiovascular Interventional Therapy Accreditation Examination under the National Health Commission.


• Chief editor of Case Analyses of Intervention of Structural Heart Diseases, Transcatheter Heart Valve Therapy, and Therapeutics of Pulmonary Hypertension; deputy chief editor of Atlas of Interventional Therapy for Miscellaneous Congenital Heart Disease.


• Obtained three research grants from the Shanghai Science and Technology Commission as first principal investigator, including one key project.


• Led three industry–academia–research projects; holds ten patents, including two invention patents, with three patents successfully translated.


• First author of over 400 papers in Chinese and international journals, with more than SCI-indexed 60 papers.


• Recipient of the Shanghai Science and Technology Progress Award (Third Prize) in 2014 as the principal investigator, and the Ministry of Education Science and Technology Progress Award (First Prize) in 2021.




助手 陈丹丹

chendandan


复旦大学附属中山医院,主治医师


复旦大学上海医学院博士研究生


上海市肺循环学组青年委员


《上海医药》杂志青年编委


参加上海市科委课题2项和国自然基金2项,主持复旦大学附属中山医院青年基金1项,国内外期刊杂志上发表数十篇文章。


专业特长:先天性心脏病,瓣膜病,肺动脉高压。


• Attending Physician, Zhongshan Hospital, Fudan University


• Doctoral Candidate, Shanghai Medical College, Fudan University


• Youth Member, Shanghai Pulmonary Circulation Group


• Youth Editorial Board Member, Shanghai Medical & Pharmaceutical Journal


• Participated in two projects of the Shanghai Science and Technology Commission and two projects of the National Natural Science Foundation; served as the principal investigator of one Youth Fund project at Zhongshan Hospital, Fudan University; has published dozens of articles in Chinese and international journals.


• Clinical expertise: congenital heart disease, valvular heart disease, pulmonary hypertension.



助手 侯士强

Hou Shiqiang