膜周部室间隔缺损经导管封堵术后并发迟发性完全性房室传导阻滞2例报告并文献复习  

Late-onset complete atrioventricular block after transcatheter closure of perimembranous ventricular septal defect: two case report and literature review

作　　者：赵武[1,2] 李奋[1] 周爱卿 高伟[1] 余志庆 孙锟[1] 黄美蓉[1] 张玉奇[1] 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心心内科,上海200127 [2]蚌埠医学院第一附属医院儿科,安徽蚌埠233004

出　　处：《临床儿科杂志》2011年第7期621-625,共5页Journal of Clinical Pediatrics

摘　　要：目的提高对膜周部室间隔缺损(PmVSD)经导管封堵术后,并发迟发性完全性房室传导阻滞(CAVB)的认识。方法回顾2例PmVSD经导管封堵术后合并迟发性CAVB的术中和术后资料,结合文献进行分析。结果例1患儿术中、术后无明确的危险因素,术后6个月出现持续性CAVB伴不完全性右束支传导阻滞,随访5年至今无症状。例2患儿术中出现一过性完全性左束支传导阻滞(CLBBB),术后5 d出现CAVB伴CLBBB,经激素等成功逆转后多次随访,ECG示Ⅰ度房室传导阻滞伴完全性右束支传导阻滞或CLBBB;术后9个月出现一过性晕厥,ECG证实间歇性CAVB伴CLBBB;目前已随访15个月,偶有晕厥发作。2例患儿家长均拒绝植入永久起搏器。结论 PmVSD经导管封堵术后并发迟发性CAVB难以预测,不论有无症状都必须长期随访。充分认识迟发性CAVB的自然史、发生率、发生机制、危险因素和防治对于尽可能减少此致命性并发症的发生是必要的。Objective To recognize the late-onset complete atrioventricular block（CAVB）after transcatheter closure of perimembranous ventricular septal defect（PmVSD）.Methods Clinical data of late-onset CAVB after trans-catheter closure of PmVSD in two pediatric patients were retrospectively analyzed,and related literatures were reviewed.Results Although the first patient had no risk factors during and after the procedure,a permanent CAVB with an incomplete right bundle branch block was developed 6 months after the procedure.No symptoms occurred during 5 years of follow-up.In the second patient a transient complete left bundle branch block（CLBBB）occurred during the procedure.CAVB with CLBBB,occurring 5 days after the procedure,was reversed by steroids and converted to normal sinus rhythm with incomplete right bundle branch block.First-degree atrioventricular block with complete right bundle branch block or CLBBB was shown in ECG during the subsequent follow-up.Nine months later,this patient experienced transient syncope,and ECG showed CAVB with CLBBB.Transient syncope attack occurred occasionally during the next 6 months of follow-up.The parents of both patients refused implantation of a permanent pacemaker.Conclusions Because late-onset CAVB after transcatheter closure of PmVSD is quite unpredictable and may occur in completely asymptomatic subjects,careful monitoring of rhythm and atrioventricular conduction is mandatory during the long time follow-up.Enhancing the understanding of natural history,incidence,pathogenesis,risk factors,treatment,and prevention of late-onset CAVB is essential to minimize the incidence of this life-threatening complication.

关 键 词：膜周部室间隔缺损 心脏导管术 完全性房室传导阻滞 迟发 

分 类 号：R541.1[医药卫生—心血管疾病]