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（徐秋萍）
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内科学新进展 第四节 心脏病介入治疗学概论
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摘 要 介入性心导管技术发展迅速，目前已发展成一门新学科——介入性心脏病学。目前介入心脏病学的应用涉及冠状动脉粥样硬化性心脏病、风湿性心脏病、先天性心脏病及心律失常等领域，成为这些疾病诊断及治疗的重要手段。本节简要介绍在什么时候如何应用介入手段治疗上述疾病。
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Abstract The cardiac catheterization techniques have currently developed into a new subject - Interventional Cardiology. At present, Interventional Cardiology has become more and more important and has been widely used in the diagnosis and treatment of coronary heart disease, rheumatic heart disease, congenital heart disease and arrhythmias. In this section, we introduce briefly when and how to use these techniques in the treatment of these diseases.
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随着医学科学的发展，心导管技术的临床应用已超越了诊断的范畴而进入治疗的领域。它的出现，使心脏血管疾病的诊断和治疗发生了翻天覆地的变化。目前，介入性心导管技术已发展成一门新兴的学科——介入性心脏病学。
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1929年，Forssmann将一根导尿管在X线下从自己左上臂静脉插入至右心房，从而开创了临床心导管的应用。20世纪40年代，Cournard、Richards使右心导管技术广泛应用于临床。1950年Zimmerman首先开展逆行性左心导管技术。1953年，Seldinger发明了经皮穿刺血管技术，使心导管插管技术大为简化。1959年，Sones应用切开肱动脉方法行选择性冠状动脉造影。60年代开始，Rickettes、Amplatz及Judkins等相继应用经皮穿刺技术，经股动脉成功地进行了选择性冠状动脉造影。1964年，Dotter用轴导管扩张外周血管取得成功，使其被誉为“血管成形术之父”。1977年9月，Gruentizig进行了首例经皮腔内冠状动脉成形术（PTCA）获得成功，PTCA的成功是介入性心脏病学发展史上最重要的里程碑。1983年，Dotter和Cragg分别报道了用镍钛合金丝制成热记忆合金内支架的实验结果，标志着内支架的系统研究进入了一个新纪元。进入80年代以后，随着PTCA的发展，各种新的冠心病介入手段不断涌现，如旋切术、冠脉内支架术、激光或超声成形术，此外，1989年加拿大Campeau首先报道了经桡动脉进行冠状动脉造影术。1995年，Kiemeneij报道经桡动脉行冠脉腔内成形术，方法和径路的发展使经皮冠心病介入治疗（PCI）日臻完善。心导管技术开展以后，使心脏电生理和心脏起搏得到了很大的发展。目前，射频消融术（RFCA）已是一种对多种室上性心动过速及某些类型的室性心律失常安全有效的根治手段。1984年，日本Inoue研制成经皮穿刺二尖瓣球囊成形术的器械，使心导管技术在一定范围内成为风湿性心瓣膜病外科闭式分离术治疗的一种替代手段。心导管技术也向先天性心脏病（简称先心病）治疗方向发展，1967年Porstmann等首创用导管法经股动脉置入泡沫塞子堵闭动脉导管未闭（PDA）获得成功，开辟了非开胸手术治疗先心病的新途径，目前已开展房间隔缺损、室间隔缺损的导管关闭手术。
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一、心脏瓣膜病的介入治疗
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