主动脉夹层壁间血肿及穿通课件

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,*,*,主动脉夹层、壁间血肿,及穿通性溃疡,主动脉夹层、壁间血肿,1,概述,急性主动脉综合征:( acute aortic syndromes,AAS),临床症状相似、发病急、威胁生命的一组主动脉疾患,发病机理不同,但可合并存在或相互演变。包括,主动脉夹层( aortic dissection,AD),主动脉壁内血肿( intramural aortic hematoma,IMH),主动脉穿通性溃疡( penetrating aortic ulcer,PAU),动脉瘤破裂,创伤性主动脉离断,概述,2,AD IMH PAU,主动脉夹层,向内破裂,向外扩张,假/真性动脉瘤,或破裂,限于中层,PAU,AD IMH PAU,3,病因和病理生理学,典型AD,发病机制,中层囊性坏死内膜撕裂,病理学特点,内膜撕裂,真假“双腔”,存在交通,远段同时存在再破口,病因:仍不明确,高血压(70%患者),Marfan综合征,医源性以及外伤,主动脉瓣狭窄等,病因和病理生理学,4,夹层的影像学征象,真假双腔部位范围大小,内膜片,内膜破口,假腔内附壁血栓,主要分支受累情况,急症指征:,AI,心包积血,胸腔积血,133,4m,缺血,00,I591,夹层的影像学征象,5,case,CT示升主动脉MH并B型AD,case,6,20.2L,假,20.2L,7,夹层破口,110例B型AD患者CT显示夹层再破口的数量,再破口数012345678910合计,例数,211166111110,夹层破口,8,急症指征-AI,B型AD突发左心功能不全,室性心律失常,升主动脉造影示主动脉瓣中等量返流,A,型AD,升主动脉近端内膜破口,头臂动脉,受累。,急症指征-AI,9,急症指征-胸腔积血,急症指征-胸腔积血,10,主动脉夹层壁间血肿及穿通课件,11,主动脉夹层壁间血肿及穿通课件,12,主动脉夹层壁间血肿及穿通课件,13,主动脉夹层壁间血肿及穿通课件,14,主动脉夹层壁间血肿及穿通课件,15,主动脉夹层壁间血肿及穿通课件,16,主动脉夹层壁间血肿及穿通课件,17,主动脉夹层壁间血肿及穿通课件,18,主动脉夹层壁间血肿及穿通课件,19,主动脉夹层壁间血肿及穿通课件,20,主动脉夹层壁间血肿及穿通课件,21,主动脉夹层壁间血肿及穿通课件,22,主动脉夹层壁间血肿及穿通课件,23,主动脉夹层壁间血肿及穿通课件,24,主动脉夹层壁间血肿及穿通课件,25,主动脉夹层壁间血肿及穿通课件,26,主动脉夹层壁间血肿及穿通课件,27,主动脉夹层壁间血肿及穿通课件,28,主动脉夹层壁间血肿及穿通课件,29,主动脉夹层壁间血肿及穿通课件,30,主动脉夹层壁间血肿及穿通课件,31,主动脉夹层壁间血肿及穿通课件,32,主动脉夹层壁间血肿及穿通课件,33,主动脉夹层壁间血肿及穿通课件,34,主动脉夹层壁间血肿及穿通课件,35,主动脉夹层壁间血肿及穿通课件,36,主动脉夹层壁间血肿及穿通课件,37,主动脉夹层壁间血肿及穿通课件,38,主动脉夹层壁间血肿及穿通课件,39,主动脉夹层壁间血肿及穿通课件,40,主动脉夹层壁间血肿及穿通课件,41,主动脉夹层壁间血肿及穿通课件,42,主动脉夹层壁间血肿及穿通课件,43,主动脉夹层壁间血肿及穿通课件,44,主动脉夹层壁间血肿及穿通课件,45,主动脉夹层壁间血肿及穿通课件,46,主动脉夹层壁间血肿及穿通课件,47,主动脉夹层壁间血肿及穿通课件,48,主动脉夹层壁间血肿及穿通课件,49,主动脉夹层壁间血肿及穿通课件,50,主动脉夹层壁间血肿及穿通课件,51,