13例经右侧入路行冠状静脉窦插管和左室电极导线植入的病例特点和手术经验  

Clinical characteristics and procedural experience of right-sided implantation of a cardiac resynchronization therapy in 13cases

作　　者：顾敏 华伟[1] 任晓庆[1] 侯翠红 牛红霞[1] 陈旭华 翟琳 张澍[1] GU Min;HUA Wei;REN Xiao-qing;HOU Cui-hong;NIU Hong-xia;CHEN Xu-hua;ZHAI Lin;ZHANG Shu(Center of Arrhythmia,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing 100037,China)

机构地区：[1]国家心血管病中心北京协和医学院中国医学科学院阜外医院心律失常中心,北京100037

出　　处：《中国心脏起搏与心电生理杂志》2020年第5期460-463,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：中央高校基本科研业务费专项资金资助(项目编号:3332019047)。

摘　　要：目的分析总结经右侧入路行冠状静脉窦插管和左室电极导线植入的病例特点和手术经验。方法回顾分析本院行心脏再同步化治疗(CRT)经右侧入路行冠状静脉窦插管和左室电极导线植入病例,分析患者资料,总结手术经验。结果共入选13例,年龄(48±21)岁,男9例。选择经右侧入路植入左室电极导线的原因:8例(62%)为升级病例,患者既往右侧植入单腔或双腔起搏器,从右侧升级为CRT;5例(38%)为新装病例,患者左侧囊袋感染,选择从右侧重新植入。13例患者中有12例(92%)经右侧入路完成冠状静脉插管和造影;1例(8%)经右侧入路插管失败,选择左侧入路插管并植入左室导线,导线尾端通过皮下隧道连接到右侧囊袋。12例经右侧入路完成插管和造影的患者中11例(92%)顺利植入左室导线;1例(8%)因无理想静脉侧枝而选择外科小切口植入左室导线并完成CRT。选择合适的外鞘管、插管工具和适度深插鞘管是提高右侧入路左室导线植入成功率的重要方法。结论右侧起搏器升级和左侧囊袋感染是选择经右侧入路植入CRT的常见原因。选择合适的鞘管和工具,以及细心操作有助于顺利完成插管和左室电极导线植入。Objective To investigate the clinical characteristics and procedural experience of right-sided implantation of cardiac resynchronization therapy(CRT).Methods Clinical data of patients undergoing CRT implantation from right side in Fuwai Hospital from 2008to 2019were retrospectively analyzed.The baseline characteristics,and imaging characteristics were analyzed,and the procedural experience was exploded.Results The average age was(48±21)years old,4cases were females.CRT upgrade from right side were attempted in 8cases(62%)and the other 5cases suffered from left side pocket infection and were planned to implant left ventricular(LV)lead from right side.A total of 12cases finished right-sided coronary sinus(CS)cannulation and 11cases succeed with LV lead implantation from the right side.Our experience on right-sided CS cannulation and LV lead implantation include suitable outer sheath selection,proper cannulation tools and deeply cannulation to ensure the stability of the sheath.Conclusions CRT upgrade and left-sided pocket infection are common reasons for right-sided CRT implantation.Knowing the feature of right-sided implantation anatomy,selecting proper implantation tools and methods are critical for successful right-sided LV lead implantation.

关 键 词：心血管病学 起搏导线 心脏再同步化治疗 左室电极导线 右侧入路 

分 类 号：R318.11[医药卫生—生物医学工程]