避免膜周部室间隔缺损经导管封堵术发生心律失常的临床探讨  

Clinical study of avoiding arrhythmia after transcatheter closure of perimembranous ventricular septal defect

作　　者：何学华[1] 龙湘党[1] 李云[1] 赵学辉[1] 刘丽萍[1] 李文娟[1] 方亦兵[1] 

机构地区：[1]湖南省人民医院小儿心血管科,湖南长沙410005

出　　处：《临床儿科杂志》2009年第10期983-986,共4页Journal of Clinical Pediatrics

摘　　要：目的通过分析膜周部室间隔缺损(perimenbranous ventricular septal defects,PMVSD)封堵治疗术前、术中和术后发生心律失常的情况,探讨介入治疗发生心律失常的相关影响因素,以期降低术后心律失常的发生率。方法分析2005年11月至2008年1月行封堵治疗的65例先心病室间隔缺损患者封堵术前、术中和术后心律失常的发生率、类型及其可能的相关因素。结果65例室间隔缺损患者术前有7例心律失常,表现为不完全或完全性右束支阻滞(IRBBB或CRBBB)、左前分支阻滞(LAH)等。术中可见多种类型的心律失常,其中在导丝和输送鞘通过室间隔时多出现房室传导阻滞(AVB)、交界性逸博、室性早博、室内差异性传导、室性心动过速等。术后心律失常发生率为12.3%(8/65),分别为Ⅰ度房室传导阻滞2例,ILBBB1例,LAH1例,IRBBB3例,室性早博1例,与术中的心律失常情况有一定的关系。术前已存在的7例心律失常经封堵治疗后,有1例Ⅰ度房室传导阻滞合并左前分支阻滞,其余无变化,随访未出现新的心律失常。对封堵术后心律失常影响因素进行单因素分析,提示与封堵器大小、缺损距三尖瓣隔瓣、主动脉右冠瓣距离、术中动-静脉轨道建立时间、术中是否出现Ⅱ度或Ⅲ度房室传导阻滞密切相关。结论临床选择VSD封堵器直径≤8cm、缺损距主动脉右冠瓣和三尖瓣隔瓣距离≥3cm的患者进行封堵治疗,可减少术后心律失常的发生率;术中建立轨道时间长短及有无发生Ⅱ度AVB和(或)Ⅲ度AVB,也是影响术后发生心律失常的重要因素。临床在把握介入治疗适应证的同时,重视PMVSD与传导系统的空间位置,避免选择过大的封堵器用于治疗,缩短手术时间,注意手术过程心电变化的提示作用,是降低PMVSD封堵术后发生严重心律失常的有效措施。Objective To examine the occurrence of arrhythmia preoperative, intraoperative and postoperative of transcatheter closure of perimembranous ventricular septal defects （PMVSD）, and to identify the related factors for decreasing the incidence of arrhythmias postoperative of interventional catheterization. Methods From November 2005 to January 2008, sixty five patients with PMVSD were treated with trancatheter intervention. The incidence and types of cardiac arrhythmias and the potential related factors were analyzed. Results In 65 cases, 7 cases suffered arrhythmias preoperative, which included incomplete or complete right bundle branch block （IRBBB or CRBBB） , left anterior hemiblock （ LAH） etc.. During the operation, especially when the guide wire and sheaths pass through the interventricular septum, various arrhythmias developed, including atrioventricular block （AVB）, junctional premature contraction, ventricular extrasystoles, intraventricular aberrant conduction, ventricular tachycardia etc. The incidence of arrhythmias postoperative was 12.3% （8 / 65） including first degree atrioventricular block in two patients, ILBBB in 1, LAH in 1, IRBBB in 3, ventricular extrasystoles in 1, which may related with the occurrence of arrhythmias during the operation; After the transcatheter intervention, 1 in 7 cases who suffered arrhythmias preoperatively developed first degree atrioventricular block combined with LAH and others had no change. No new arrhythmias occurred during the follow-up. Single-factor analysis showed that the related factors of arrhythmias postoperative of transcatheter closure were occluder size, the distance from the defects to the septal cusp of tricuspid valve, the distance from the defects to the aortic valve, the arteriovenous track building time, and occurance of the second or third degree atrioventricular block. The occurrence of postoperative arrhythmias had no obvious correlation with that of preoperative. Conclusions Using the occluder with diameter ≤ 8 cm and selectin

关 键 词：室间隔缺损 心律失常 封堵术 

分 类 号：R541.1[医药卫生—心血管疾病]