可控弯鞘在马歇尔静脉无水乙醇化学消融中的应用经验  

Practical experience with the steerable sheath during ethanol infusion into the vein of Marshall

作　　者：付超 孙丽娟 赵紫旭 高洁 王雨锋 孔祥怡 郭丽珠[1] 郭雪原[1] 左嵩[1] 桑才华[1] 龙德勇[1] 马长生[1] FU Chao;SUN Lijuan;ZHAO Zixu;GAO Jie;WANG Yufeng;KONG Xiangyi;GUO Lizhu;GUO Xueyuan;ZUO Song;SANG Caihua;LONG Deyong;MA Changsheng(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心血管内科,100029 [2]滨州市人民医院心内科 [3]滨州市人民医院全科医学科 [4]四川省人民医院老年医学科

出　　处：《心肺血管病杂志》2025年第3期221-226,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：心血管诊疗技术与器械教育部工程研究中心(1300-12400606)。

摘　　要：目的:探讨可控弯鞘在马歇尔静脉(vein of Marshall,VoM)无水乙醇化学消融(ethanol infusion in the vein of Marshall,EIVOM)中的临床应用策略。方法:纳入2023年1月至2023年12月期间于北京安贞医院接受EIVOM治疗的心房颤动患者191例,术中全部首选固定弯长鞘行EIVOM,其中26例进一步应用可控弯鞘。据此将患者分为固定弯鞘组(n=165)以及可控弯鞘组(n=26),对比两组患者的临床基线资料、术中资料以及EIVOM相关并发症。结果:纳入的191例患者平均年龄(61.8±10.1)岁,其中男性111例(58.1%),两组患者临床基线资料差异无统计学意义。经过术中资料对比,可控弯鞘组的26例患者中,15例患者出现三尖瓣峡部偏长(38.0±1.1)mm、10例患者的Marshall静脉开口在右前斜30°下距离冠状窦口较近(7.7±0.9)mm、7例患者出现欧氏嵴偏高(12.4±1.0)mm;全部191例患者中,3例患者EIVOM治疗未成功,两组患者均未出现并发症。结论:在Marshall静脉无水乙醇化学消融时,三尖瓣峡部偏长、Marshall静脉开口较近、欧氏嵴偏高等情况应用可控弯鞘有助于消融的操作且不会增加并发症的发生率。Objective:To explore the clinical application of using a steerable sheath during ethanol infusion into the vein of Marshall(EIVOM).Methods:A total of 191 patients with atrial fibrillation who received ethanol infusion into the vein of Marshall at Anzhen Hospital in Beijing from January 2023 to December 2023 were selected as the study subjects.All of them used fixed bent sheaths as the first choice to perform EIVOM during the procedure,of which 26 were changed to steerable sheaths afterwards.Patients were divided into the fixed bending group(n=165)and the steerable group(n=26)according to different sheaths,and compared the clinical baseline data,intraoperative data,and incidence of complications between the two groups.Results:The mean age of the 191 participants was(61.8±10.1)years,of which 111(58.1%)were male,and there was no statistically significant difference in the baseline clinical data between the two groups.After comparison of intraoperative data,among the 26 patients in the steerable curved sheath group,15 patients had a long cavo-tricuspid isthmus(38.0±1.1)mm,10 patients had the opening of the vein of Marshall closer to the coronary sinus at 30°of the right anterior oblique(7.7±0.9)mm,and 7 patients had a high Eustachian ridge(12.4±1.0)mm.Among all 191 patients,EIVOM treatment was unsuccessful in 3 patients,and there were no complications in both groups.Conclusions:In the process of ethanol infusion into the vein of Marshall,,the use of the steerable sheath with a longer cavo-tricuspid isthmus,closer Marshall venous opening,and higher Eustachian ridge facilitates the ablation maneuver and does not increase the incidence of complications.

关 键 词：Marshall静脉 心房颤动 可控弯鞘管 化学消融 

分 类 号：R54[医药卫生—心血管疾病]