心血管外科基础.ppt

单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,一，历史,历 史,Dr.Daniel Hale Williams,a surgeon from Chicago who successfully operated on a patient with a wound to the chest involving the pericardium and the heart.,1893 year,历史,Dr.Ludwig Rehn,a surgeon from Frankfurt,Germany,who performed the first successful suture of a human heart wound.,1896year,In 10 years,124cases reported,Mortality 60%,历史,心导管,Although cardiac catheterization is,not,considered heart surgery,it is an invasive procedure and some catheter procedures have,replaced heart operations.Warner Forssmann is credited with,the first heart catheterization.He performed the procedure,on himself and reported it in,Kleinische Wochenschrift,.,In,1956,Forssmann shared the Nobel Prize in Physiology or Medicine,with Andre F.Cournand and Dickenson W.Richards,历史,体外循环前的瓣膜手术,HEART VALVE SURGERY BEFORE THE ERA OF CARDIOPULMONARY BYPASS,The first clinical attempt to open a stenotic valve was carried,out by Theodore Tuffier on July 13,1912,历史,体外循环前的先心病手术,CONGENITAL CARDIAC SURGERY BEFORE THE HEART-LUNG MACHINE ERA,John Streider,at the Massachusetts,General Hospital first successfully interrupted a ductus on,March 6,1937.The patient was septic and died on the fourth,postoperative day.At autopsy,vegetations filled the pulmonary,artery down to the valve,On August 16,1938,Robert Gross,at Boston Childrens Hospital,operated on a 7-year-old girl,with dyspnea after moderate exercise,历史,体外循环前的心脏手术,CONGENITAL CARDIAC SURGERY BEFORE THE HEART-LUNG MACHINE ERA,Dr.,Clarence Crafoord,in Stockholm,Sweden,successfully resected a coarctation of the aorta in,a 12-year-old boy on October 19,1944,体外循环的发展,THE EVELOPMENT OF CARDIOPULMONARY BYPASS,The development of the heart-lung machine made repair of intracardiac,lesions possible.To bypass the heart,one needs,a basic understanding,of physiology of the circulation,a method of preventing the,blood from clotting,a mechanism to pump blood,finally,a method to ventilate the blood,THE DEVELOPMENT OF CARDIOPULMONARY BYPASS,Heparin was discovered by a medical student,Jay McLean,McLean described his finding in February 1916,the first clinically successful total left-sided,heart bypass in a human,was performed on July 3,1952,THE DEVELOPMENT OF CARDIOPULMONARY BYPASS,A schematic drawing by IBM engineers of the pump oxygenator they designed and constructed under Gibbons direction,先心病手术,ASD was closed successfully,on May 6,1953,with the,Gibbon,-IBM heart-lung machine.,Lillehei,et al,91,used their technique at the University of Minnesota,to correct a ventricular septal defect in a 12-month-old infant,on March 26,1954,John W.Kirklin,and colleagues launched their open heart program on March 5,1955,体外生命支持EXTRACORPOREAL LIFE SUPPORT,The development of membrane oxygenators in the,1960s permitted longer support.,Donald Hill and colleagues,in 1972,treated a 24-year-old man who developed shock lung,after blunt trauma,心肌保护,MYOCARDIAL PROTECTION,Melrose et al in 1955 presented the first experimental studydescribing induced arrest by potassium-based cardioplegia.,First successful intracardiac repairs using cardiopulmonary bypass or cross-circulation,Atrial septal defect 1953 Gibbon,Ventricular septal defect 1953 Lillehei,Cross-circulation,Complete atrioventricular canal 1954 Lillehei,Cross-circulation,Tetralogy of Fallot 1954 Lillehei,Cross-circulation,Tetralogy of Fallot 1955 Kirklin,Cardiopulmonary bypass(CPB),Total anomalous pulmonary veins 1956 Kirklin,First successful intracardiac repairs using cardiopulmonary bypass or cross-circulation,Congenital aneurysm sinus of Valsalva 1956 Kirklin,Congenital aortic stenosis 1956 Kirklin,First direct visual correction Aortopulmonary window,1957 Cooley,First closure using CPB,Double outlet right ventricle 1957 Kirklin,Extemporarily devised correction,Corrected transposition great arteries 1957 Lillehei,Transposition great arteries:atrial switch1959 Senning,First successful intracardiac repairs using cardiopulmonary bypass or cross-circulation,Coronary arterial-venous fistula 1959 Swan,Ebsteins anomaly 1964 Hardy,Repair of atrialized tricuspid valve Tetralogy with pulmonary atresia,1966 Ross,Used aortic allograft,Truncus arteriosus 1967 McGoon,Used aortic allograft,Tricuspid atresia 1968 Fontan,Physiologic correction Single ventricle 1970 Horiuch,Subaortic tunnel stenosis 1975 Konno,Transposition great arteries:arterial switch 1975 Jaten,Anatomic correction Hypoplastic left heart syndrome 1983 Norwood,Two-stage operationPediatric heart transplantation 1985 Bailey,瓣膜手术,VALVULAR SURGERY:CARDIOPULMONARY BYPASS ERA,The first successful,aortic valve replacement was performed,by Dr.Dwight Harken and associates in 1960。A caged ball valve was,used.,That same year,Starr and Edwards successfully replaced the,mitral valve using a caged ball valve of their own design,冠状动脉手术,CORONARY ARTERY SURGERY,心律失常,ARRHYTHMIC SURGERY,Sealy,et al at Duke University developed the first successful,surgical treatment for cardiac arrhythmias.,A 32-year-old,fisherman was referred for symptomatic episodes of atrial tachycardia,that caused congestive heart failure.On May 2,1968,心肺移植,HEART,HEART-LUNG,AND LUNG TRANSPLANTATION,The first human-to-human heart transplant occurred December,3,1967,at the Groote Schuur Hospital in Capetown,South Africa.,The surgical team,headed by,Christiaan Barnard,A clinical trial of heart-lung transplantation was commenced,at Stanford University in 1981,by,Reitz,et al,主动脉手术,THORACIC AORTA SURGERY,心脏辅助装置,HEART ASSIST AND ARTIFICIAL HEARTS,IABP,主动脉内气囊反搏,心室辅助装置,国内发展史,二尖瓣分离 兰锡纯1954年2月,低温直视手术梁其琛1957年1月,主动脉弓替换李迎汉1960年12月,国内发展史,体外循环手术开始于1958年苏鸿熙,二尖瓣替换1965年蔡用之,复杂先心汪曾炜,丁文祥,冠状动脉郭加强1974年11月,心律失常张全复1978年5月,心脏移植张世泽1978年,我科发展史,50年代建科,60年代起步,7080停顿,90年代发展,21世纪展望,常见疾病分类,先天性心脏病简单,复杂（紫绀）,后天性心脏病,1，瓣膜,2，冠心病,3，肿瘤,4，心肌病,5，动静脉脉疾病,先天性心脏病,后天性瓣膜病,冠心病,体外循环,原理低温,抗凝,泵血,氧和,插管,氧和器,泵,术后监护,呼吸,循环,目前面临的问题,终末期心衰,房颤,复杂先心病,大血管,展望,临床,人工器官,血管,瓣膜,心脏,微创,展望,基础,减轻低温及体外循环损伤,