心脏再同步治疗中心脏静脉夹层的处理  

Treatment of coronary venous dissection in cardiac resynchronization therapy

作　　者：严激[1] 陈康玉[1] 徐健[1] 芮世宝[2] 钱钧[3] 汪靖[4] 杨玉雯[2] 

机构地区：[1]安徽省立医院心内科,合肥230001 [2]皖南医学院弋矶山医院心内科 [3]马鞍山市中心医院心内科 [4]黄山市人民医院心内科

出　　处：《中华心律失常学杂志》2013年第1期50-52,共3页Chinese Journal of Cardiac Arrhythmias

基　　金：2010年安徽省卫生厅医学科研重点项目（2010A002）

摘　　要：目的总结心脏再同步治疗（CRT）中心脏静脉夹层的发生情况和处理方法，为并发症的防治提供经验。方法选取2001年12月至2012年5月符合CRT适应证的患者348例。心脏静脉逆行造影充分显示心脏静脉各属支，将左心室导线植入靶静脉。观察心脏静脉夹层的发生情况、处理方法和结果。结果335例患者成功植入CRT，手术成功率为96．3％。共14例出现心脏静脉夹层，发生率为4．02％。8例为轻度夹层，密切观察后成功植入左心室导线；5例为中度夹层，其中4例应用导丝技术成功植入左心室导线，1例患者择期植入左心室导线；另有1例严重夹层，出现心包积液和明显症状，积极对症处理后，择期成功手术。结论CRT植入术应注意规范、轻柔操作，避免夹层的发生。一旦出现夹层，要根据严重程度选择不同的处理方法，有经验的术者可考虑应用本文所述的直接导丝技术。Objective To provide experience for prevention and treatment of coronary venous dissec- tion by summarizing its occurrence and processing strategy in cardiac resynchronization therapy（CRT）. Meth- ods Three hundred and forty-eight patients who met the indications for CRT were enrolled in this studyfrom December 2001 to May 2012. The targeted left ventricular leads were implanted by vein approach, after a coro- nary sinus angiography was performed. The occurrence, treatment and results of coronary venous dissection were analyzed. Results Fourteen coronary venous dissection were occurred in 348 patients, 335 patients received CRT successfully（96. 3% ）. 8 of the 14 patients with venous dissection were mild dissection, left ventricular lead was implanted successfully with close observation. The venous dissection was moderate in 5 patients, one of them received left ventrieular lead implantation electively ,the others who were in stable condition received im- plantation by percutaneous coronary intervention guide wire technic. The severe coronary venous dissection oc- curred in one patient with obvious symptoms and pericardial effusion. The patient received CRT electively after actively treatment. Conclusions Coronary venous dissection couldbe prevented by standardized and gently op- erating. The processing strategy based on the severity of dissection.

关 键 词：心脏再同步治疗 左心室导线 冠状静脉窦 夹层 

分 类 号：R543[医药卫生—心血管疾病]