膜部室间隔缺损封堵术后完全性左束支传导阻滞治疗效果分析  

Long-term follow-up of different treatment on complete left bundle branch block after closure of perimembranous ventricular septal defect in children

作　　者：陈轶维[1] 赵文婥 王顺民[1] 杜欣为[1] 吉炜[1] 朱荻绮[1] 陈丽君[1] 张志芳[1] 李奋[1] CHEN Yiwei;ZHAO Wenchuo;WANG Shunmin;DU Xinwei;JI Wei;ZHU Diqi;CHEN Lijun;ZHANG Zhifang;LI Fen(Shanghai Children’s Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心心脏中心

出　　处：《临床儿科杂志》2020年第2期123-128,共6页Journal of Clinical Pediatrics

基　　金：上海市卫健委青年科研课题(No.20174Y0106)

摘　　要：目的探讨儿童膜部室间隔缺损(VSD)封堵术后完全性左束支传导阻滞(CLBBB)的治疗及预后。方法回顾分析2009年2月至2019年6月就诊的18例VSD封堵术后CLBBB患儿的临床资料。结果18例接受VSD封堵术并经心电图检测确诊CLBBB患儿的平均年龄为5.69±2.33岁(3岁2个月~10岁5个月),男性11例、女性7例,随访时间中位数5年(3个月~10年)。14例无心力衰竭患儿中4例经糖皮质激素治疗CLBBB即恢复,随访3~6个月各项指标均无异常;8例随访5~10年,无不适,心电图无变化,心功能、左室射血分数、心房利钠肽均无异常,但左室舒张末期内径(LVDD)增大;2例接受封堵器取出及VSD修补术,1例术后出现完全性右束支传导阻滞,余无异常,另1例术后出现完全性房室传导阻滞,植入起搏器,随访1年QRS波时限较术前缩短,心功能无异常,LVDD增大。4例合并心力衰竭患儿中3例行心脏再同步化治疗(CRT)植入术,1例行左室起搏,术后QRS波均<150 ms;1例行CRT术后3天因急性心力衰竭死亡,另3例随访1~2年心功能明显改善。结论对于VSD封堵术后早期出现CLBBB患儿,糖皮质激素可能有效,若无效,可选择手术取出封堵器,但有发生完全性房室传导阻滞的风险。若合并心力衰竭,CRT或左室起搏治疗可能有一定效果。Objectives To investigate different treatments and prognosis on complete left bundle branch block(CLBBB)in children after closure of perimembranous ventricular septal defect(VSD).Method Eighteen cases with CLBBB after perimembranous VSD intervention diagnosed from February 2009 to June 2019 were enrolled in this study.The patients were divided into 4 groups according to different treatments such as close follow-up,glucocorticoid treatment,removing closure device and CRT treatment.The follow-up results including clinical signs and symptoms,chest radiography,electrocardiogram(ECG),echocardiography(ECHO)and type B natriuretic peptide(BNP)were analyzed.Results A total of 8 patients accept close follow-up for 5 to 10 years without any symptoms or signs,showed normal cardiac function(NYHA I)and normal left ventricular ejection fraction(LVEF)by ECHO.The left ventricular end-diastolic diameter(LVDD)were larger according to references.There were 4 cases suffered CLBBB on 1 to 4 days after intervention.They recovered after accepting glucocorticoid treatment for 1 week.The ECG,ECHO and BNP tests were normal after 6 month.There were 2 cases admitted to remove the closure device and accepted surgical repair.The first case accepted surgery after 6 months of intervention.The ECG after postoperative 1 week showed complete right bundle branch block until now.The other observation target including ECHO and BNP were normal after one-year follow-up.Another case accepted surgery 7 years after intervention,but complete atrioventricular block occurred after surgery and not recovered 1 week later.The patient accepted double chamber pacemaker implantation and showed normal cardiac function excepting the enlarged LVDD after 1 year follow up.There were 4 cases with heart failure accepted standard medicine therapy for at least six months and had no obvious improvement.Three(3)of them accepted CRT implantation,another case accepted permanent pacemaker implantation(left atrial sensing,left ventricular pacing)for personal reasons.The QRS wave

关 键 词：室间隔缺损介入术 完全性左束支传导阻滞 心功能不全 心脏再同步化治疗 

分 类 号：R726.5[医药卫生—儿科]