心源性脑栓塞PPT课件

• 1953 Cooley and DeBakey used artificial grafts for repair
• 1953 Bahnson introduced aneurysmorrhaphy
• 1957 cardiopulmonary bypass became available
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Definition
CT：脑内多发梗塞
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定位诊断
• 双侧颈内动脉系统，左侧著 • 椎基底动脉系统？
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定性诊断
• 心源性栓塞 主动脉机械瓣膜组织 栓子脱落
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Aortic Dissection
Anatomy,Physiology and Principles of Therapy
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History
• 1555 – Vesalius diagnosed a pulsating tumor near the vertebrae in a patient’s back and called it “a dilatation of the aorta”1826
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Natural History
• Not well documented • Signs, symptoms and prognosis related to the size
of the aneurysm • Thoracic aneurysms larger than 6 cm are more
心源性脑栓塞
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病历特点
• 中年男性，反复发作渐进性病程； • 既往高血压史，夹层动脉瘤及主动脉瓣关闭不
全换瓣术后3年，口服抗凝药不规范。近2年多 次脑梗塞史。 • 发病表现为反复发作的神经功能缺损，渐进性 的神经功能缺损。 • 查体主要表现为言语表达障碍，构音含混，右 面部麻木及右肢轻偏瘫，及右侧同向偏盲。 • 辅助检查：凝血象（INR）偏低；
• Early operations were designed to produce distal internal fenestration to cause downstream decompression of the aorta.
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HiБайду номын сангаасtory
• 1951 Lam and Aram introduced homografts for repair of descending thoracic aneurysms
• Column of blood is driven by the force of the left ventricular systolic pressure which strips the intima from the adventitia
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Definition
• Acute – less than 14 days old • Chicken or the egg ? – Hemorrhage in the
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Pathophysiology
• Law of Laplace: As a sphere increases in size, the wall tension of the sphere increases
• Weakened wall • Dilatation • Expansion with pressure-related symptoms • Rupture
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Causes of Dissection
• Inherent weakness of the aortic wall • Hypertension – 70-90% • Pregnancy • Iatrogenic • Bicuspid aortic valve and coarctation • Closed chest trauma
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Definition
• Aortic dissection – Sudden catastrophic event in which a tear in the intima allows blood to escape from the true lumen of the aorta rapidly separating the inner from the outer layer of the media
• True aneurysm – localized enlargement of the aorta contained by all the layers of the aortic wall
• False aneurysm – enlargement contained by the aortic adventitia and periaortic fibrous tissue.
• 1826 – Laennec introduced the term dissecting aneurysm
• 1800’s – surgery was performed on the entity by John Hunter, Astley Cooper and others even before the era of general anesthesia
media causes rupture of the intima or dissecting hematoma in an intimal tear.
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Causes of Aneurysm
• Medial degeneration and local dilatation • Atherosclerosis • Syphilis (ascending only) • Bacterial infections (mycotic) • Congenital abnormalities • Trauma • Annuloaortic ectasia
prone to rupture than the smaller ones • 5 year survival for symptomatic aneurysms is 27%