室间隔缺损经导管关闭术后传导阻滞的相关因素分析  

Analysis on risk factors of heart block after ventricular septal defect closure with double-discs membranous VSD occluder

作　　者：王一斌[1] 华益民[1] 刘瀚旻[1] 周同甫[1] 石晓青[1] 汪周平[1] 

机构地区：[1]四川大学华西第二医院儿童心血管疾病介入诊疗中心,四川成都610041

出　　处：《临床儿科杂志》2007年第12期1002-1004,共3页Journal of Clinical Pediatrics

摘　　要：目的探讨采用膜部室间隔缺损(室缺)双盘封堵器关闭膜周型室缺术后发生传导阻滞的相关因素。方法采用临床回顾性对照研究的方法,分析患儿年龄、性别、缺损位置、缺损直径、封堵器大小、封堵器直径与缺损直径的差值及封堵器形状与术后房室传导阻滞的相关性。结果220例患儿室缺封堵术后,发生不同类型的传导阻滞55例(发生率25%)。其中以束支传导阻滞最多见,Ⅱ度Ⅱ型以上的传导阻滞发生率较低。其构成比分别为完全性右束支阻滞(CRBBB)27.3%,完全性左束支阻滞(CLBBB)5.5%,左前半支阻滞(LABBB)23.6%,右束支阻滞合并左前半支阻滞(RBBB+LABBB)30.9%,Ⅱ度Ⅱ型1.8%,高度3.6%,Ⅲ度7.3%。结论经双盘封堵器关闭膜部室间隔缺损术后传导阻滞的发生与患儿年龄、缺损位置、缺损直径相关。膜周型室缺与房室传导束密切的解剖关系是经导管封堵术后传导阻滞发生率较高的主要原因,术前如何通过影像学分型,选择恰当的病例,以及封堵方式和封堵器材的改进将是今后亟待解决的课题。Objectives To study risk factors of heart block resulting from closure of VSD with double-discs membranous ventricular septal defect （VSD） occluder. Methods Two hundred and twenty patients with VSD and device closure were included in the study. The age of patients, position and diameter of VSD, the size and shape of the occluder and the difference of diameter between VSD and occluder, were analyzed retrospectively. Results Among 220 subjects, 55 developed various kinds of heart block （incidence was 25%）. The types of heart block were as following： complete right bundle branch block （27.3%）, complete left bundle branch block （5.5%）, left anterior bundle branch block （23.6%）, complete right bundle branch block plus left anterior bundle branch block （30.9%） Moitz type-Ⅱ （1.8%）, high-grade atrioventricular block （3.6%）, and Ⅲ° o atrioventricular block （7.3%）. Conclusions Heart block resulting from closure of VSD with double-discs membranous VSD occluder in perimembranous VSD is related to the age of patients, position of VSD, and diameter of VSD, The close anatomic location of perimembranous VSD and conduct bundle is the major cause of heart block resulting from closure of VSD with double-discs membranous VSD occluder, In order to reduce the incidence of heart block, it is important to identify various types of VSD preoperatively and choose proper mode of the occluder accordingly, Ouality of the occluder should also be improved in the fu-ture.

关 键 词：室间隔缺损 介入治疗 传导阻滞 相关因素 

分 类 号：R725.4[医药卫生—儿科]