儿童右心耳瘤合并房性快速心律失常三例分析  

Clinical analysis of right atrial appendage aneurysms complicated by atrial tachyarrhythmias in three children

作　　者：张仪[1] 李小梅 江河 张福强 靳永强 刘海菊 戈海延 Zhang Yi;Li Xiaomei;Jiang He;Zhang Fuqiang;Jin Yongqiang;Liu Haiju;Ge Haiyan(School of Clinical Medicine,Tsinghua University,Beijing 100084,China;Department of Pediatric Cardiology,Heart Center,the First Hospital of Tsinghua University (Beijing Huaxin Hospital),Beijing 100016,China)

机构地区：[1]清华大学临床医学院,北京100084 [2]清华大学第一附属医院(北京华信医院)心脏中心小儿科,100016

出　　处：《中华儿科杂志》2019年第2期98-102,共5页Chinese Journal of Pediatrics

基　　金：首都临床特色应用研究(Z181100001718207);北京市朝阳区科技计划(CYSF1725).

摘　　要：目的探讨儿童右心耳瘤合并房性快速心律失常的临床特征及治疗效果。方法回顾性分析2016年1月至2018年4月就诊于清华大学第一附属医院心脏中心小儿科的3例右心耳瘤合并房性快速心律失常患儿的临床资料,年龄1.0~5.3岁,体重10.0~17.1 kg。分析房性快速性心律失常的临床特点、心电图及超声心动图特征、抗心律失常药物治疗效果、射频消融和右心耳瘤切除治疗效果及术后病理结果。结果3例右心耳瘤患儿分别于胎龄36周、1月龄、4月龄被发现房性快速心律失常。2例为房性心动过速、心房扑动及心房颤动交替出现,超声心动图显示右心耳瘤样扩张,行右心耳瘤切除术;1例为房性心动过速,超声心动图未发现右心耳异常,行射频消融术,术中标测为起源于右心耳尖部的局灶性房性心动过速,射频消融未能成功,行右心耳切除术中显示为右心耳瘤。3例患儿术前多种抗心律失常药物联合治疗无效或部分有效。右心耳瘤切除术后,3例原有的房性快速性心律失常消失,2例出现新起源点房性心动过速,抗心律失常药物可转复并维持窦性心律。3例患儿病理示部分心房腔呈囊性扩张,囊壁纤维化,心房肌广泛纤维化伴心肌萎缩及囊状扩张,心肌厚薄不均,心肌间质广泛纤维化。结论先天性右心耳瘤患儿的房性快速心律失常可出现在胎儿期或生后早期,超声心动图易漏诊,抗心律失常药物疗效差,射频消融风险大且效果受限,手术切除可取得良好的效果。Objective To investigate the clinical features and results of treatment for right atrial appendage aneurysms complicated by atrial tachyarrhythmias in children. Methods This retrospective study included three children with right atrial appendage aneurysm complicated by atrial tachyarrhythmias (aged 1.0 to 5.3 years,weight 10 to 17.1 kg) who were hospitalized at the Pediatric Cardiology Department (Heart Center) of the First Hospital of Tsinghua University (Beijing Huaxin Hospital) during the period from January 2016 through April 2018.The patients′ clinical features,the results of electrocardiogram (ECG) and echocardiography,the effects of therapeutic interventions (antiarrhythmics,radiofrequency ablation,and surgical resection of right atrial appendage aneurysm) and the results of pathological assessment were analyzed. Results Three cases of right atrial appendage aneurysm were diagnosed at 36 weeks of gestational age,1 month and 4 months after birth respectively.In two cases,ECG showed alternating episodes of atrial tachyarrhythmias including atrial tachycardia,atrial flutter,and atrial fibrillation,and echocardiography showed aneurysmal dilatation of right atrial appendage.These two cases underwent right atrial appendage aneurysm resection.In the remaining one case of atrial tachycardia,echocardiography did not visualize important lesions in the right atrium,thus the intracardiac electrophysiologic study and radiofrequency ablation were performed;and focal atrial tachycardia originating from the apex of right atrial appendage was mapped but failed to be ablated;consequently,the patient received the right atrial appendage resection,in which the right atrial appendage aneurysm was found.Preoperative multiple antiarrhythmics showed only modest or no efficacy for all the three cases.The atrial tachyarrhythmias disappeared in all the three cases after right atrial appendage aneurysm resection.Postoperative atrial tachycardias associated with new foci of impulse formation developed in two cases.These two patients

关 键 词：心耳 心动过速 儿童 

分 类 号：R725.4[医药卫生—儿科]