室间隔缺损封堵术后发生Ⅲ度房室传导阻滞的临床分析  

Clinical analysis of third degree atrioventricular block after transcatheter closure of ventricular septal defect

作　　者：刘凌[1] 刘君[1] 高磊[1] 谭慧莲[1] 郑庆厚[1] 崔东 戚艳超 张大红 王震[1] LIU Ling;LIU Jun;GAO Lei;TAN Hui-lian;ZHENG Qing-hou;CUI Dong;QI Yan-chao;ZHANG Da-hong;WANG Zhen(Department of Cardiology,the First Hosptial of Heibei Medical University,Shijiazhuang 050031,China)

机构地区：[1]河北医科大学第一医院心内科,河北石家庄050031

出　　处：《中国介入心脏病学杂志》2018年第8期435-438,共4页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨室间隔缺损(VSD)介入封堵术后发生Ⅲ度房室传导阻滞(AVB)的特点、转归及防治。方法回顾性分析2004年2月至2016年12月在河北医科大学第一医院心内科行VSD介入封堵术的患者1428例,分析患者封堵术前心电图及术后出现AVB的时间、持续时间及转归情况。结果 1428例患者中封堵术后发生Ⅲ度AVB 9例(0.6%)。5例患者发生在封堵术后3~5 d,其中1例经激素治疗1 d后恢复正常,另外4例应用激素、临时起搏器治疗1~3 d后心电图恢复正常;1例发生在封堵术后4 d,经激素和临时起搏器治疗无效,外科开胸取伞修补术后即刻心电图恢复正常;2例封堵术后1年余发现Ⅲ度AVB,植入永久性心脏起搏器;1例术后即刻出现I度AVB及不完全性右束支传导阻滞,术后23 d为完全性左束支传导阻滞,术后1、2、3、6个月复查仍为完全性左束支传导阻滞,术后1年复查发现Ⅲ度AVB,于外科行取伞修补术,术后13 d心电图恢复正常。结论Ⅲ度AVB是VSD介入封堵术后的严重并发症。提高手术治疗技术,选择合适封堵器,术后严密观察,及时发现并早期积极治疗可在一定程度上减少Ⅲ度AVB的发生。Objective To discuss the characteristics, prognosis and preventive method of third degree atrioventricular block（AVB） af ter transcatheter closure of ventricular septal defect. Methods From February 2004 to December 2016, a total of 1428 VSD patients had received transcatheter closure in the First Hospital of Hebei Medical University. We reviewed their electrocardiogram before transcatheter closure, the time of appearance and duration of third degree AVB and their clinical outcome. Results Nine patients（9/1428, 0.6%） developed third degree AVB after the transcatheter closure. In 5 cases, the AVB occurred 3-5 days af ter the procedure. Among these 5 patients, 1 patient recovered af ter 1 day of steroid treatment. The other 4 patients had received steroid and temporary pacing, and recovered to normal ECG af ter 1-3 days of treatment. One developed third degree AVB four days af ter the transcatheter closure, and not responsed to steroid and temporary pacing. His electrocardiography returned to normal immediately af ter surgical operation of retreival of occluder. Two cases were found to have third degree AVB over 1 year after the closure and required permanent pacemaker implantation. One case developed f irst degree AVB and incomplete right bundle branch block immediately af ter transcatheter closure,and changed to complete lef t bundle branch block 23 days af ter the closure. The complete left bundle branch block was present at 1, 2, 3, 6 months after the transcatheter closure,and third degree AVB was found at 1 year after the procedure. This patient received surgical removal of the occluder and repair of the VSD. His ECG became normal 13 days af ter operation. Conclusions Third degree atrioventricular block was a serious complication af ter transcatheter closure of ventricular septal defect. Improvement in operation technique, correct choice of occlude sige and close monitor with early intervention may reduce the rates of third degree AVB af ter transcatheter closure for VSD.

关 键 词：室间隔缺损 封堵术 Ⅲ度房室传导阻滞 

分 类 号：R541.1[医药卫生—心血管疾病]