永存左上腔患者起搏导线植入路径探讨：附28例分析  

Operative approach of permanent pacemaker implantation in patients with persistent left superior vena cava

作　　者：胡芬[1,2] 周颖 潘轶文 许逸飞 徐耕[1] 

机构地区：[1]浙江大学医学院附属第二医院心内科,杭州31000 [2]浙江省平湖市第一人民医院心内科,浙江平湖314200 [3]浙江绿城心血管病医院心内科 [4]浙江省中医药大学附属第一医院心内科

出　　处：《临床心血管病杂志》2016年第7期751-754,共4页Journal of Clinical Cardiology

摘　　要：永存左上腔静脉（persistent left superior vena cava,PLSVC）在正常人群中发病率为0.3%～0.5%,其中约12%的人群合并其他心血管异常[1-2]。最常见PLSVC为PLSVC直接流入冠状静脉窦,开口于右房,占PLSVC的80%～92%[1,3]。文献对PLSVC有多种分型报道[1,4-5]。但根据PLSVC流入心脏部位的不同,常见的为4种类型：Ⅰ型PLSVC流入冠状静脉窦,右上腔静脉缺如;Ⅱ型PLSVC左右上腔静脉均存在,两者之间不存在交通支;28PLSVC patients with pacemaker implantation was included.The classification of PLSVC were14,7,7for type A（both right and left superior vena cava,an innominate vein joins them）,B（both right and left superior vena cava,but no innominate vein joins them）,C（persistent left superior vena cava and absent right superior vena cava）respectively among 28 patients.PM implantation were performed in 25 patients,including 1magnetic resonance imaging compatible pacemaker,while one CRT-D and two ICD implantation were performed in other 3patients.6patients were diagnosed as PLSVC before operation,then leads were implanted via the right subclavian vein;however,the left ventricular lead implantation was failed then ICD implantation was performed instead in one patient although the other 5implantations are successfully performed.Leads were implanted via the left subclavian vein in 18 of the 22patients（81.8%）diagnosed as PLSVC during operation and via the right subclavian vein in the other 4patients who turned out to be PLSVC B patients.Active-fixation leads were applied in 26 of the 28 PLSVC patients.24 atrial leads were all implanted into auricula dextra.16 of the 26 right ventricle leads were placing in right ventricular apex,and the other 10 in right ventricular septum.1left ventricular pacing lead was located in the anterior-lateral vein.All the patients were followed up for mean 6.7months,and the pacing threshold and sensing parameters showed no significant differences compared with that during operation（P〉0.05）.There was no significant difference of threshold and sensing parameters between active-fixation leads and inactive-fixation leads（P〉0.05）.Leads were all implanted successfully without any serious complication,such as ad dislocation,perforation and phrenic nerve stimulation（PNS）.

关 键 词：永存左上腔静脉 起搏 主动导线 

分 类 号：R541.1[医药卫生—心血管疾病]