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ID:62093434
大小:3.55 MB
页数:71页
时间:2021-04-15
《最新主动脉夹层动脉瘤 3D重建图PL-药学医学精品资料.ppt》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
1、最新主动脉夹层动脉瘤3D重建图PL-药学医学精品资料History1555–Vesaliusdiagnosedapulsatingtumornearthevertebraeinapatient’sbackandcalledit“adilatationoftheaorta”18261826–Laennecintroducedthetermdissectinganeurysm1800’s–surgerywasperformedontheentitybyJohnHunter,AstleyCooperandoth
2、ersevenbeforetheeraofgeneralanesthesiaEarlyoperationsweredesignedtoproducedistalinternalfenestrationtocausedownstreamdecompressionoftheaorta.History1951LamandAramintroducedhomograftsforrepairofdescendingthoracicaneurysms1953CooleyandDeBakeyusedartificialg
3、raftsforrepair1953Bahnsonintroducedaneurysmorrhaphy1957cardiopulmonarybypassbecameavailableDefinitionAorticdissection–Suddencatastrophiceventinwhichatearintheintimaallowsbloodtoescapefromthetruelumenoftheaortarapidlyseparatingtheinnerfromtheouterlayerofth
4、emediaColumnofbloodisdrivenbytheforceoftheleftventricularsystolicpressurewhichstripstheintimafromtheadventitiaDefinitionAcute–lessthan14daysoldChickenortheegg?–Hemorrhageinthemediacausesruptureoftheintimaordissectinghematomainanintimaltear.CausesofAneurys
5、mMedialdegenerationandlocaldilatationAtherosclerosisSyphilis(ascendingonly)Bacterialinfections(mycotic)CongenitalabnormalitiesTraumaAnnuloaorticectasiaCausesofDissectionInherentweaknessoftheaorticwallHypertension–70-90%PregnancyIatrogenicBicuspidaorticval
6、veandcoarctationClosedchesttraumaPathophysiologyLawofLaplace:Asasphereincreasesinsize,thewalltensionofthesphereincreasesWeakenedwallDilatationExpansionwithpressure-relatedsymptomsRuptureNaturalHistoryNotwelldocumentedSigns,symptomsandprognosisrelatedtothe
7、sizeoftheaneurysmThoracicaneurysmslargerthan6cmaremorepronetorupturethanthesmallerones5yearsurvivalforsymptomaticaneurysmsis27%whereas58%withasymptomaticonessurvivedthesameperiodoftime.RuptureisthemostcommoncauseofdeathNaturalHistoryManypatientswithdissec
8、tiondieacutelyduetocardiactamponadeordissectionoftheLAD8%ofascendingrupturessurvivewithouttreatment75%survivedescendingdissectionClassificationTypeI-BeginsattheaorticvalveandmayproceedtoandincludetheabdominalaortaTy
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