室间隔缺损介入术后完全性左束支传导阻滞9例分析  

Analysis of 9 cases of complete left bundle branch block after interventional treatment for ventricular septal defect

作　　者：曹黎明[1] 王凤鸣[1] 秦玉明[1] 杨世伟[1] 陈金龙[1] 庄思斯 朱善良[2] 

机构地区：[1]南京医科大学附属儿童医院心血管内科,江苏南京210008 [2]南京医科大学附属儿童医院超声科,江苏南京210008

出　　处：《中国实用儿科杂志》2017年第5期357-360,共4页Chinese Journal of Practical Pediatrics

摘　　要：目的探讨室间隔缺损(VSD)介入术后并发完全性左束支传导阻滞(CLBBB)的高危因素及预后。方法回顾2010年4月至2015年12月南京医科大学附属儿童医院心脏中心VSD介入术后并发CLBBB 9例患儿的一般资料及随访结果,分析9例患儿年龄、VSD及封堵器类型、术后CLBBB出现时间及转归、左心室舒张末期内径(LVEDD)及左心室射血分数(LVEF)变化情况。结果年龄:除1例年龄偏大外,其余8例均在5岁以内。VSD及封堵器类型:膜周型VSD伴假性膨出瘤3例,嵴内型VSD 6例;1例选择对称型封堵器,2例选择小腰大边型封堵器,6例选择偏心型封堵器。术后CLBBB出现时间及转归:术后3 d内8例、术后1个月1例;8例术后早期并发CLBBB患儿在住院期间经药物治疗后有4例恢复正常,其中2例术后1个月复查,再次出现CLBBB;1例术后1个月开始出现CLBBB的患儿接受外科手术后,次日CLBBB恢复正常。LVEDD及LVEF变化:2例分别于术后6、12个月出现不同程度LVEDD增大,其余7例未出现明显LVEDD增大,9例均未出现LVEF下降。结论VSD介入治疗应严格遵循专家共识、规范化操作;对低龄VSD患儿介入封堵治疗应谨慎;在保证封堵治疗效果的前提下,尽量选择对称型封堵器。VSD介入术后并发CLBBB近期预后良好,但部分病例远期出现LVEDD增大,对于术后出现CLBBB病例,应严格长期随访。Objective To investigate the risk factors and prognosis of CLBBB complicated with VSD after intervention- al therapy. Methods The general data and follow-up results of 9 cases of complete left bundle branch block （CLBBB） after interventional treatment for ventricular septal defect （VSD） were reviewed from April 2010 to December 2015 in our hospital heart center. The age of children, type of VSD and occluder, the occurrence time and prognosis of postopera- tive CLBBB and the change of LVEDD and LVEF were analyzed. Results Age ： 1 case 〉 5 years and 8 cases 〈 5 years ; VSD and occluder type ： perimembranous VSD with pseudo aneurysm in 3 cases and intracristal VSD in 6 cases; there was 1 case of symmetry occluder, 2 cases of small waist big edge type occluder, and 6 cases of eccentric type occluder. Postoperative CLBBB occurrence time and prognosis ： CLBBB occurred in postoperative 3 days in 8 cases, including 4 cases recovered to normal after drug treatment and 2 cases again had CLBBB in postoperative [ month; 1 case began to appear CLBBB in postoperative 1 month and returned to normal after receiving surgery the next day. Left ventricle end- diastolic dimension（LVEDD） and ejection fraction of LV （LVEF） changes： 2 cases had increased LVEDD in 6 and 12 months after operation, respectively ; the other 7 cases did not have obvious LVEDD increase ; all the 9 cases did not have decreased LVEF. Conclusion VSD interventional therapy should strictly follow the expert consensus and standardized operation ; VSD interventional occlusion therapy for young children （ 〈 5 yrs） should be cautious ; in the premise of ensur- ing the occlusion effect of interventional therapy, the symmetric type occluder should be selected first. CLBBB complicat-ed with VSD after interventional therapy has a good re- cent prognosis, but in some cases the long-term LVEDD increases; CLBBB complicated with VSD after interven-tional therapy cases should be strictly followed up.

关 键 词：室间隔缺损 介入治疗 完全性左束支传导阻滞 儿童 

分 类 号：R72[医药卫生—儿科]