經(jīng)皮冠狀動(dòng)脈干預(yù)的相對(duì)禁忌癥：嚴(yán)重左室功能衰竭課件

1、Percutaneous Coronary Interventions for Patients with Relative Contra-indications: Severely Depressed Left Ventricular Function Great Wall International Conference on Cardiology. Beijing 11.5.2005 Thach Nguyen MD FACC FACP FSCAIWhat is the most Common Cause of Death among Patients Undergoing PCI? In

2、 Which Scenario I Will Do PCI Even The EF Is Low (25%) ? 3Scenario 1: AMI (EF25%) Patient A: ST Segment Elevation. Heart Rate=70 and Blood Pressure 130/80Patient B: ST Segment Elevation in Inferior leads, 2,3,F and V2R, V3R = RV MI HR:120 BP: 80/60. Mortality = ?Patient C: ST Segment Elevation in An

3、terior leads V1-V6. HR:120 BP: 80/50 How much is the mortality after PCI?Scenario 2: Stable Angina (EF25%) Patient has low EF however there is a large area of ischemia on Nuclear scan What Do These 2 sets of Patients Have in Common? Moderate Risk Patient (Ejection Fraction 25%) 1. Frank Heart Failur

4、e No2. Mitral Regurgitation Mild 3. Diagonal or Posterior Descending Artery or Obtuse Marginal OPEN Why I am Interested in Patency of PDA and Diagonal Branch? Right dominantRCAPDALeft dominantPDALADLCxLAO viewsScenario 3: Stable Angina (EF25%) Patient has low EF and no other non-invasive data Resear

5、ch Question 2 2. Is mitral regurgitation a passive event secondary to left ventricular dilation or it is an important part of LV remodeling as programmed by intelligent design? Scenario 4: Which One I refuse to Do?Dilated cardiomyopathy and frank heart failure Scenario 4: Which One I refuse to Do?CL

6、INICAL CRITERIASevere dilated cardiomyopathy withModerate to severe Mitral Regurgitation Moderate to severe Tricuspid Regurgitation Moderate to severe aortic regurgitation Scenario 4: Which One I refuse to Do?HEMODYNAMIC CRITERIASevere dilated cardiomyopathy withElevated LVEDPClosed Diagonal and clo

7、sed Posterior Descending Artery from either a dominant RCA or dominant Obtuse Marginal branch Research Question 3. 3. We can open and secure a good epicardial flow however, I strongly believe that the microvascular system is regulated more by receptors than by passive gradient between upstream and d

8、ownstream pressure. In patients with diffuse triple vessel disease and severe LV dysfunction, the problem is not just flow disturbances and it is more suspected by inability of translation from energy brought by blood flow to contraction. What Do I Look When I Come To Evaluate a Patient with Very Lo

9、w Ejection Fraction (25%) For PCI ? When I Start the PCI, How I Know I am Getting into Trouble ? 1. Slow Rate of Rise 2. Widening of QRS THE PATIENT IS GOING INTO SHOCKCheck LVEDP and Rate of RiseConclusions Conclusions: 1. What is the patient subset with highest mortality? 2. How to know which AMI patients will die in the near future? 3. Which patient has end-stage