2014年华西临床超声模拟培训课程-教学日志
本帖最后由 心超 于 2014-3-13 23:45 编辑左心室十七节段的超声解剖
今天下午5点40从彭州打车回成都，6点45顺利抵达新八教学楼4楼，上楼一看，本周科室的助教已经将4003和4006教室打开，已经有多名住院医师在4003教室等候，细心的助教已经将空调打开，教室很温暖。姚大夫也来了，他是今天超声课的助教之一，姚大夫来自安徽皖南医学院，来华西参加3个月的TEE培训。姚大夫和来自辽宁桦甸的进修医生一起把黑板放置好，写好板书，正好7点，准时开课。导入部分（5min）想了解大家对构建心脏模型的认识，问了大家3个问题，第一，请大家闭上眼睛，问问自己，你脑海中的心脏模型到底是什么样子的？有人回答，心脏就像拳头，也有人回答有4个腔......, 总之，回答都不满意，接着勉励大家：一个医生如果心脏模型都是模模糊糊，那太说不过去了！，第二个问题：你习惯从什么方位，什么角度观察心脏，你脑海中的心脏模型是面对你，还是背对你？大多数人回答是面对心脏，后排的一位进修医生，勇敢地回答说，他习惯在心脏的背面俯视心脏，我相信他的话是发自内心的，大多数人一开始构建心脏模型是都习惯采取这样的视角。第三，左心房在什么位置？多数人回答：左心房在心脏的左侧，有一个年轻大夫回答左心房在心脏的最后方。正是我想要的答案。借题发挥，讲了一下超声解剖的学习方法。
进入正题，讲了了3D立体思维的养成和生活中的例子，接着是如何描述人体方位，如何把心脏模型放回到人体，碰巧我们的助教团队的4员大将到了，带来了心脏模型，用模型这个问题非常直观。用96版的美国操作指南中的十七节段和冠脉供血的资料讲了如何立体地观察心脏。
http://www.heartworks.me.uk/videos/Home_Heart_390x410.swf
最后是workshop，报数后分组，统计人数24人，1-8号首发为A组，即 wet-lab组由来自安贞医院的熊大夫和安徽的姚大夫共同负责；9-16号首发为B组，即Sim-lab组，由我和湖北的刘大夫共同负责；17-24号首发为C组，即image-lab组，由来自湘雅的袁大夫和河南的郭大夫负责。
华西临床超声课程为什么要引入Wet lab？
本帖最后由 心超 于 2014-3-14 19:13 编辑wet lab 是心血管医学模拟培训常用的方法，也是学习心脏超声的必要课程之一。
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耶鲁大学-超声病例
本帖最后由 心超 于 2014-3-17 23:03 编辑http://www.yale.edu/imaging/chd/resources/headers/spacer.gifhttp://www.yale.edu/imaging/chd/resources/headers/spacer.gifhttp://www.yale.edu/imaging/chd/resources/headers/spacer.gifhttp://www.yale.edu/imaging/chd/resources/headers/spacer.gifhttp://www.yale.edu/imaging/chd/resources/headers/spacer.gifhttp://www.yale.edu/imaging/chd/resources/headers/spacer.gifhttp://www.yale.edu/imaging/chd/resources/headers/spacer.gifhttp://www.yale.edu/imaging/chd/resources/headers/spacer.gifhttp://www.yale.edu/imaging/chd/resources/headers/spacer.gifhttp://www.yale.edu/imaging/chd/resources/headers/spacer.gifhttp://www.yale.edu/imaging/chd/resources/headers/spacer.gif
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http://www.yale.edu/imaging/chd/resources/headers/chd_header2_12.gifTable of Contents
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ForwardUser InstructionsIllustrated GlossaryAbbreviationsSyndromes
Permission for re-useLeft to Right Shunts[*]Atrial septal defects[*]secundum[*]sinus venosus[*]sinus venosus at IVC[*]patent fossa ovale[*]Ventricular septal defects[*]perimembranous[*]perimembranous (aneurysm)[*]muscular[*]apical[*]supracristal[*]Atrioventricular septal defect[*]Patent ductus arteriosus[*]Partial anomalous venous return[*]Aorto-pulmonary artery connection[*]Coronary artery - pulm. artery connectionCyanotic Disease[*]Tetralogy of Fallot[*]Case collection[*]d-Transpo. great arteries[*]Tricuspid atresia[*]Eisenmenger syndrome[*]Ebstein's anomaly[*]Pulm. valve stenosis[*]Hypoplastic left heart[*]Pulm. atresia with VSD[*]Truncus arteriosus[*]Double outlet RV[*]Pulm. arteriovenous malformationsUniventricular heart
Pulm. atresia, intact septum
Vena cava return to left atrium
Total anomalous pulm venous return
[*]Common atriumAbnormal Connection[*]d-Transpo. great arteriesCongenitally corrected transposition (l-Transpo.)
Double outlet RV
Total anomalous pulm venous return
Partial anomalous venous return
Vena cava return to left atrium
[*]Double inlet LVLeft Heart Obstructions[*]Aortic valve stenosis[*]Coarctation[*]Subaortic stenosis[*]Hypoplastic left heart[*]Cor triatriatum[*]Supravalvar aortic stenosisInterrupted aortic arch
Mitral valve stenosis
[*]Pulmonary vein stenosisRight Heart Obstructions[*]Pulm. valve stenosis[*]Pulmonary artery stenosisAbnormal Cardiac PositionViscero-atrial situs solitus
Dextrocardia
Viscero-atrial situs inversus
Situs ambiguous
[*]Heart in right hemithoraxOther Conditions[*]Cardiomyopathy[*]Marfan[*]Left superior vena cava[*]Non-compaction of myocardium[*]Uhl's (RV dysplasia)Coronary artery anomaly
[*](HHT) Hereditary Hemangiotelangiectasis[*]Idiopathic Pulm Artery Dilation[*]Cleft Mitral ValvePericardial defect
[*]Fetal CirculationSurgeries[*]Glenn (classic)[*]Bi-directional Glenn[*]Take-down Glenn[*]Fontan[*]Blalock-Taussig[*]Jatene (with LeCompte)[*]Norwood[*]Mustard[*]RossASD
VSD
[*]Atrio-ventricular Septal Defect[*]Tetralogy of Fallot-1[*]Tetralogy of Fallot-2Senning
Damus-Kaye-Stansel
Rastelli
Blalock-Hanlon
Rashkind
[*]Pulmonary Artery BandPotts
[*]WaterstonPercutaneous Procedures[*]Percutaneous closure PDA[*]Clamshell closure ASD[*]Pulmonary artery stent[*]Coarct balloon dilation[*]Coarct stentingAdult Clinical Cases[*]Secundum ASD, 23 y.o.[*]Truncus re-op, 16 y.o.[*]Tetralogy of Fallot, 45 y.o.[*]Coarctation, 32 y.o.[*]Memb. Vent. Sept. Aneur.[*]Tricuspid atresia, 43 y.o.[*]Eisenmenger with VSD[*]Down's with AV Defect[*]Transpo. Great Art., 27 y.o.[*]Vent. Sept. Defect, 89 y.o.[*]Partial Anom Ven Return with PHT[*]Marfan's in pregnant woman[*]Quad-cusp Ao valve, 42 y.o.[*]Unicuspid Ao valve, 39 y.o.[*]Rt coronary anomaly, 54 y.o.OverviewIncidence, prevalence Genetics Syndromes with CHD Clinical pearls Antibiotics prophylaxis Contraception & pregnancy [*]Surgery vs. percutaneoushttp://www.yale.edu/imaging/chd/resources/pixel.gif
Self-Assessment Quizhttp://www.yale.edu/imaging/chd/resources/pixel.gif
Normal Echo Anatomy
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Copyright 2001, Yale University School of Medicine. All rights reserved.
February 22, 2001 (PL)
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心超老师在TEE的模拟教学及TEE在麻醉学科的应用推广付出了很大的心血，很值得吾辈敬佩，正是因为他辛苦、不懈的付出，才使得后来者的路走得更易！ 3.13晚讲课现场
回复 7# mazuigyc
上课前一天去购买猪心，不幸，已售完。嘱咐老板第二天预留三个，且多留一些心脏附属血管。
老板很守信，预留四颗，冷藏。腔静脉未见，稍有遗憾。
上课开始，心超老师讲解心脏模型的立体重建，左心室的17节段。
30分钟的理论讲解结束，各小组开始工作。
本人WET LAB组。我们的任务是逐步解剖心脏展示主动脉、主动脉瓣、左右冠状窦、左右冠脉开口、左右冠脉及分支走形、左心室的冠脉支配，然后再按照左心室基底段、中间段、心尖段及心尖的分段，分层切开左心室，展示左心室不同节段的切面，并调整角度与TEE超声表现相对应。
虽然是猪心，跟人心的解剖对应关系真的很好，用它来帮我们理解TEE的检查切面真的很有用！
对于几乎零基础来学习TEE的我来说，真的太有帮助了。
以前总觉得TEE对于麻醉医生来说门槛太高，起步太难。现在有心超老师的带领，信心猛增。 本帖最后由 心超学袁2014 于 2014-3-16 20:18 编辑
回复 5# 心超
谢谢宋老师设计的形象生动的授课！印象深刻！这样一节科就深记了左室17节段！
请袁大夫结合3月17日-29间的病例回答下面的问题
本帖最后由 心超 于 2014-3-17 23:26 编辑image tee cases echocardiogram
January 2014
January Question: In this patient with a history of a myocardial infarction, which coronary artery is most likely affected? Assuming there is no other major coronary disease, is the circulation right or left dominant? (Video clips 1,2,3) What about in the patient represented in video clip 4?
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Video '1' (click to enlarge)
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Video '2' (click to enlarge)
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Video '3' (click to enlarge)
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Video '4' (click to enlarge)
January answer: In first 3 clips, there is evidence of a basal inferior and posterior wall infarction. This implies RCA involvement with a right dominant circulation. The dominance means that the PDA or posterior descending artery, which supplies the posterior wall, originates from the RCA. In the last video clip the anterior, lateral and posterior walls are affected; this means that the left main coronary is affected and the circulation is left dominant, that is, the PDA comes off the circumflex. See image.
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Answer Image '1' (click to enlarge)
请北京的熊大夫结合3月17日的病例回答下列问题
March Question: What's wrong with this picture?http://depts.washington.edu/anesth/images/tee_pictures/2014_03_video01.gif
Video '1' (click to enlarge)
本周4，二尖瓣TEE切面解剖预习
本帖最后由 心超 于 2014-3-17 23:38 编辑http://pie.med.utoronto.ca/PIE/PIE_assets/SWF/valves/heart_and_valves%20v05.swf 忘了告诉大家，楼上的瓣膜模型可以用鼠标拖动!
心血管文献集
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Copyright 2007 Cardiovascular Anthology jing pi dao guan zhu dong mai zhi ru shu 回复 13# 心超
从1-3视频显示后侧壁、后壁基底段心肌活动不良，应该是右冠狭窄堵塞，且是一个右侧优势心；视频4显示前壁、侧壁、后壁心肌收缩下降，这提示左主干堵塞，且后降支起源于回旋支，是个左侧优势心！TEE刚入门，对心肌收缩功能的判断还不是很有把握，有不对的地方请宋老师指正！深以致谢！
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