Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic...
-
Upload
slide-sharer -
Category
Health & Medicine
-
view
96 -
download
1
description
Transcript of Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic...
![Page 1: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/1.jpg)
Prof. Dr. Rıza Türköz
Novel fenestration designs for control led venous f low shunting in fai l ing Fontans with systemic
venous hypertension Cardiac Surgeon: Definition of the
problem
11
![Page 2: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/2.jpg)
Normal kalbin çal ışması
22
![Page 3: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/3.jpg)
Tek ventrikül Morfoloj is i
33
![Page 4: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/4.jpg)
Tek ventrikül insidensi Tek ventrikül insidensi
Tek ventrikül insidensi her 10 000 doğumda 4-8 arasında * Tüm konjenital kalp hastalıklarının %7.7 *
%3.2 Hipoplastik sol kalp sendromu
%1.3 Triküspit atrazisi %3.2 Tüm diğer patolojiler
44* O’Leary PW . Prevalence, c l inical presentation and natural history of patients with single ventricle . Progress in Pediatric Cardiology 16 (2002 ) 31–38
![Page 5: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/5.jpg)
Opere edi lmemiş tek Opere edi lmemiş tek ventrikül olgularında sağ ventrikül olgularında sağ
kalım kalım Moodie ve ark* 83 vakalık en geniş serinin izlemi İyi gelişmiş sol ventrikülü olan vakaların %70, 16 yaşından
önce kaybediliyor Sağ ventrikül morfolojili olguların ise tanı sonrası 4 yılda
sadece %50 si hayatta kalıyor. En önemli ölüm sebepleri
Aritmi
KKY Ani açıklanamayan ölüm
55*Moodie DS et al. Long-term follow-up in the unoperated univentricular heart. Am J Cardiol. 1984;53:1124
![Page 6: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/6.jpg)
Tek ventrikül Fizyoloj is i
66
![Page 7: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/7.jpg)
Glenn Operasyonu --Fontan Operasyonu
77
![Page 8: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/8.jpg)
88
Tek ventrikül Fizyolojisi Tek ventrikül Fizyolojisi
![Page 9: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/9.jpg)
99
Tek ventrikül Fizyolojisi Tek ventrikül Fizyolojisi
![Page 10: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/10.jpg)
Fontan Fizyoloj is i
Sistemik ve pulmoner venöz sistemin ayrılması
Sistemik venöz dönüş ile PA arasında darlık olmayan, pasif akım sağlıyan bir yol oluşturulması
Fizyolojik avantajı
Siyanozun düzelmesi Volüm yükünün azalması
1010
![Page 11: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/11.jpg)
1111
![Page 12: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/12.jpg)
1212
![Page 13: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/13.jpg)
Ori j inal Fontan Operasyonu
1971
1313
Fig. 1. The Fontan operation as originally described by F. Fontan for tricuspid atresia was comprised of five steps: (1) Glenn shunt to the right lung; (2) harvest of the main pulmonary artery from the right ventricular outflow tract; (3) anastomosis of main pulmonary artery to the right atrium with an interposed homograft valve; (4) placement of a homograft valve in the inferior vena cava-right atrium junction; and (5) closure of atrial septal defect. (Reprinted with permission from Fontan F, Baudet E, Thorax 1971;26:240.)
![Page 14: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/14.jpg)
Kreutzer Modifikasyonu APC1973-1982
1414
![Page 15: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/15.jpg)
Björk modifikasyonu 1979
1515
![Page 16: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/16.jpg)
De Leval - TCPC 1988
Lateral Tünel Dacron veya PTFE ile
atriumun bölünmesi Düz bir yol oluşturulması
Türbulans ve enerji kaybı olmadan laminar akım sağlanması
1616
![Page 17: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/17.jpg)
Fenestre Fontan1990
Bridges Sistemik venöz P azaltır
Mortalite ve morbidite azalır Plevral effüzyon, assit, hepatik
konjesyon ve protein kaybettiren enteropati daha az
Preload ve CO sürdürür Sistemik Satürasyon düşer
1717
![Page 18: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/18.jpg)
Ekstrakardiak Fontan 1988-1990
1818
![Page 19: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/19.jpg)
Ekstrakardiak Fontan × Ekstrakardiak Fontan × Lateral Tunel Lateral Tunel
Daha fazla laminar akım Atriyumda min. insizyon ve sütür Atrium daha düşük P
Atrial aritmi riski daha az
PVAtriumda yabancı materyel yok Baffle leak ihtimali yok
Sistemik tromboemboli riski az Koroner sinüs düşük P venöz atrium tarafında kalır Kardioplejik arrest gerekmez, CPB süresi daha kısa
Daha iyi LV fonksiyonları Fenestrasyon ilavesi veya revizyonu CPB’suz. Sistemik venöz ve pulmoner venöz dönüş anomalisinde
teknik daha kolay Tranplantasyonda pulmoner arter rekons daha kolay
Dezavantajları Antikoagülasyon
Büyük greft yerleştirme zorluğu
1919
Avantaj ları
![Page 20: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/20.jpg)
TCPC sonrası TCPC sonrası komplikasyonlar komplikasyonlar Kava-pulmoner dolaşımda P artmasına bağlı
SVCS, hepatomegali, assit, ödem, siyanoz (fens ile)
Düşük kardiak debi Med tedavi, assist device , takedown, transplantasyon
Akut KC disfonksiyonu Aritmi Diğerleri
Plevral effüzyon, şilotoraks, perikardial effüzyon
Tromboembolik olaylar, Frenik sinir paralizisi
Diğer kronik komplikasyonlar Venöz kollateral gelişimi, intrahepatik venöz fistüller , PAVM, sistemik-pulm
arterial kollateral , gelişme geriliği, aritmiler, PLE, plastik bronşitis, tromboembolik olaylar
2020
![Page 21: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/21.jpg)
2121
![Page 22: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/22.jpg)
TCPC sonrası uzun TCPC sonrası uzun dönemde komplikasyonların dönemde komplikasyonların Fizyopatoloj is i Fizyopatoloj is i Sistemik venöz basıncın artması ve pulsatil akımın kaybolması
Ventrikül fonksiyonlarının bozulması Pulmoner venöz obstrüksiyon AV kapak yetmezliği
Unbalansa CAVSD sık Aritmiler
Atrium büyümesi, insizyonu ve dikişler ile : atriopulmoner anastomozlar >lateral tünel >EKF
İlerleyici Siyanoz
SVP yüksekliği ile çeşitli kollateral ve AVM
2222
![Page 23: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/23.jpg)
Fenestrasyon
2323
![Page 24: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/24.jpg)
Fenestrasyon rutin veya r iskl i vakalarda ?
Tek AC Fontan
Yüksek pulmoner arter basıncı
Yüksek pulmoner vasküler rezistans
Anormal pulmoner arter anatomisi
Sağ ventrikül dominansı
Bozuk ventrikül fonksiyonu
Belirgin AV kapak yetmezliği
Erken cerrahi
2424
![Page 25: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/25.jpg)
Fenestrasyon Avantaj ları - - Dezavantaj ları
AvantajPostoperatif hemodinami iyiYB süresi kısa Toraks tüpü süresi kısa Yatiş kısa Erken mortalite Geç mortalite Erken veya geç dönemde keşke koysaydım. Venöz sistemden anjio ve kateter
Avantaj
DezavantajSiyanozTromboemboli**Kapamak için tekrar girişimAritmi ?
2525
![Page 26: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/26.jpg)
Fenestrasyonun seyri
2.5-4 mm=== %50-90 1 yılda kapanıyor
4 mm > === %40-70 1 yılda kapanıyor
2626
![Page 27: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/27.jpg)
2727
![Page 28: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/28.jpg)
Basınça göre değişen fenestrasyon
2.5 mm altında fenestrasyonda tromboemboli riski çok düşük
İhtiyaç halinde (sistemik venöz ile pulmoner venöz atrium arasında P artması ile) ~8-10 mmHg
Fenestrasyon çapı artarak hemodinami rahatlıyabilirmi ?
2828
![Page 29: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/29.jpg)
2929
![Page 30: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/30.jpg)
3030
![Page 31: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/31.jpg)
3131
![Page 32: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/32.jpg)
3232
![Page 33: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/33.jpg)
3333
![Page 34: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/34.jpg)
3434
![Page 35: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/35.jpg)
3535
![Page 36: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/36.jpg)
3636
![Page 37: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/37.jpg)
3737
![Page 38: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/38.jpg)
3838
![Page 40: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/40.jpg)
TEŞEKKÜR TEŞEKKÜR EDERİMEDERİM
4040
![Page 41: Novel fenestration designs for controlled venous flow shunting in failing Fontans with systemic venous hypertension Cardiac Surgeon: Definition of the problem](https://reader033.fdocuments.us/reader033/viewer/2022052908/559702161a28ab624f8b45ad/html5/thumbnails/41.jpg)
4141