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小儿膜周部室间隔缺损介入治疗发生高度房室传导阻滞的特点及其处理（附9例报道）(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2005年第2期
页码:
181-183
栏目:
介入治疗
出版日期:
2005-03-05

文章信息/Info

Title:
Characteristics and treatments of high degree atrioventricular block following the transcatheter occlusion of perimembranous ventricular septal defect in childrenAnalysis of 9 cases
作者:
李寰;  张玉顺;  刘建平;  刘兵;  王海昌;  魏晓挴;  陈兰芳;  代政学;  王垒;  马东江; 王晓燕
第四军医大学西京医院心脏内科,陕西 西安710032
Author(s):
LI Huan;  ZHANG Yushun;  LIU Jianping;  LIU Bing;  WANG Haichang;  WEI Xiaomei;  CHEN Lanfang;  DAI Zhengxue;  WANG Lei;  MA Dongjiang;  WANG Xiaoyan
Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi′an， Shaanxi 710032 China
关键词:
室间隔缺损;  介入治疗;  房室传导阻滞
Keywords:
ventricular septal defect;  interventional treatment;  atrioventricular block
分类号:
R541.1；R541.76
DOI:
-
文献标识码:
A
摘要:
目的 探讨经导管介入治疗小儿膜周部室间隔缺损（VSD）发生高度房室传导阻滞(AVB)的特点及其处理。方法 选择我科年龄小于12岁VSD患者，经导管介入治疗发生高度AVB的患儿，共计9（男4，女5）例，连续观察所有患儿封堵术前以及发生高度AVB后ECG的变化及其处理。结果 ①术中发生高度AVB 5例，分别在AVB后10 min～46 h恢复正常窦性心律。其中3例为持续Ⅲ度AVB，经处理后2例转为持续Ⅱ度Ⅱ型，1例仍为持续Ⅲ度AVB ；间歇性Ⅱ度Ⅱ型和Ⅲ度AVB 各1例。②4例在术后12 h~10 d出现AVB，3例在AVB后1~12 d恢复；1例未恢复，给予永久起搏器治疗。其中3例为间歇性高度或Ⅲ度AVB，1例为持续性Ⅲ度AVB。③术后AVB恢复的3例，在高度AVB时, ECG均表现为完全性右束支传导阻滞+左前分支传导阻滞。AVB后3~5 d，ECG电轴左偏进一步加重，以后电轴左偏逐渐减轻，左前分支阻滞逐渐消失，至恢复时ECG仅遗留右束支传导阻滞。结论 小儿膜周部VSD介入治疗有发生高度AVB的危险。对于高危患者，应尽早治疗。
Abstract:
AIM To investigate the characteristics and treatments of high degree atrioventricular block (AVB) after transcatheter occlusion of perimembranous ventricular septal defect (VSD) in children. METHODS 9 perimembranous VSD cases (including 4 male and 5 female) aged under 12 suffered from high degree AVB when receiving transcatheter occlusion. Serial changes of ECGs were recorded. RESULTS ①5 cases suffered from high degree AVB during occlusion. Among them, 3 cases were persistent Ⅲ°AVB, of which 2 cases changed into Ⅱ°Ⅱ AVB and 1 case was still Ⅲ°AVB after treatments in the procedure; the AVB types of another 2 cases were intermittent Ⅲ°AVB and intermittent Ⅱ°Ⅱ AVB, respectively. All 5 cases were recovered to normal sinus rhythm 10 minutes to 46 hours late. ② 4 cases suffered from high degree AVB in 12 hours to 10 days after occlusion, 3 of which appeared high degree AVB intermittencely and 1 of which appeared AVB persistently. 3 cases recovered in 1 to 12 days after occlusion, and 1 case could not recover and had to be given permanent pacemaker. ③The ECG characteristics of 3 recovered cases appeared complete right bundle block and left anterior hemiblock when high degree AVB happened. The left axis deviation aggravated 3 to 5 days late, and, then gradually lessened. In the end left anterior hemiblock disappeared, leaving right bundle block unchanged. CONCLUSION Transcatheter occlusion of perimembranous VSD in children has risk of leading to high degree AVB. The high risk factors include age of patient under 5 years old, small distance between VSD and tricuspid valve, repeated irritating VSD during procedure and aggravated complete right bundle block accompanied with left anterior hemiblock after occlusion. The patients who have high risk factors should be routinely treated with corticosteroid to prevent AVB.

参考文献/References

［1］ 孔祥清. 先天性心脏病介入治疗［M］. 南京：江苏科学技术出版社,2003.

［2］Milo S, Ho SY, Wilkinson JL, et al. Surgical anatomy and atrioventricular conduction tissues of hearts with isolated ventricular septal defects［J］. J Thorac Cardiovasc Surg, 1980,79(2):244-255.

［3］Moss AJ, Klyman G, Emmanouilides GC. Late onset complete heart block: newly recognized sequela of cardiac surgery［J］. Am J Cardiol, 1972，30:884-887.

备注/Memo

备注/Memo:
收稿日期：2004-12-10.
更新日期/Last Update: 2010-01-05