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
• Early operations were designed to produce distal internal fenestration to cause downstream decompression of the aorta.
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History
• 1951 Lam and Aram introduced homografts for repair of descending thoracic aneurysms
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
• 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
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
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；
• 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 eபைடு நூலகம்a of general anesthesia
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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
• 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.
prone to rupture than the smaller ones • 5 year survival for symptomatic aneurysms is 27%
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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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Natural History
• Not well documented • Signs, symptoms and prognosis related to the size
of the aneurysm • Thoracic aneurysms larger than 6 cm are more
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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