胸腔镜辅助下心耳切除术治疗儿童难治性心耳起源房性心动过速的单中心经验  

Experience of video-assisted thoracoscopic atrial appendage resection for refractory atrial tachycardia originating from atrial appendage in children in single center

作　　者：郁夏风 刘一为 刘旭[1] 张浩[1] 孙彦隽[1] YU Xia-feng;LIU Yi-wei;LIU Xu;ZHANG Hao;SUN Yan-jun(Department of Cardiothoracic Surgery,Shanghai Children’s Medical Center,Shanghai Jiaotong 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胸外科,上海市200127

出　　处：《中国心血管病研究》2025年第4期337-341,共5页Chinese Journal of Cardiovascular Research

基　　金：2024年度医疗服务与保障能力提升项目(国家临床重点专科建设项目)(10000015Z155080000004);上海市“科技创新行动计划”医学创新研究专项(20MC1920400);儿童心血管贵州省科技创新领军人才工作站{KXJZ[2024]035}。

摘　　要：目的 总结电视胸腔镜下心耳切除术病例,分析心导管射频消融术结合心耳切除术治疗心耳起源房性心动过速的临床经验及治疗效果。方法 回顾2021年4月至2024年3月间上海儿童医学中心收治的8例心耳起源的房性心动过速实施VAST下心耳切除术的患儿。所有病例均为射频消融治疗后复发,其中男性5例,女性3例,年龄7~10岁,体重19~46 kg。5例起源于左心耳,3例起源于右心耳。结果 8例患儿术前超声心动图测得左心室射血分数(LVEF)为(40.18±12.27)%,左心房内径(LAD)为(2.88±0.48)cm,左心室舒张末期内径(LVEDD)为(5.25±0.74)cm。胸部正位片测心胸比0.63±0.07。N末端B型利钠肽原(NT-proBNP)为(4351.00±2718.00)pg/ml。均实施电视胸腔镜心耳切除术,所有患儿术后即刻转为窦性心律,无复发。术后超声心动图测得LVEF(58.88±9.81)%,LAD(2.35±0.29)cm,LVEDD(4.46±0.82)cm,心胸比(0.53±0.06),NT-proBNP(834.00±397.00)pg/ml。门诊随访6个月至3年,期间无死亡,无复发,未发现严重并发症。结论 对于儿童难治性心耳起源房性心动过速,VATS心耳切除术是一种理想的手术方式。VATS下通过电动切割缝合器进行心耳切除安全有效,且更为便捷。Objective To explore the therapeutic effect of video-assisted thoracoscopic atrial appendage resection on recurrent atrial tachycardia originating from atrial appendage after radiofrequency catheter ablation.Method Between April 2021 and March 2024.8 cases of children with atrial tachycardia originating from the atrial appendage who underwent thoracoscopic atrial appendectomy at Shanghai Children's Medical Center were reviewed.All the cases were recurrent after radiofrequency ablation,including 5 males and 3 females,aged 7-10years,body weight 19-46 kg.5 cases originated from left atrial appendage and 3 cases originated from right atrial appendage.Result The preoperative echocardiography measured the left ventricular ejection fraction(LVEF) was(40.18 ± 12.27)%,left atrial diameter(LAD) was(2.88 ± 0.48) cm and left ventricular end-diastolic dimension(LVEDD) was(5.25±0.74) cm;the cardiothoracic ratio was(0.63±0.07) and the N-terminal pro-B-type natriuretic peptide(NT-proBNP) was(4351.00±2718.00) pg/ml.All the patients underwent video-assisted thoracoscopic atrial appendage resection and immediately turned to sinus rhythm without recurrence.Postoperative echocardiography measured the LVEF was(58.88 ± 9.81)%,LAD was(2.35 ± 0.29) cm and the LVEDD was(4.46 ± 0.82) cm;the cardiothoracic ratio was(0.53±0.06) and the NT-proBNP was(834.00±397.00) pg/ml.During the outpatient followup ranging from 6 months to 3 years,there were no deaths,no recurrences and no severe complications observed.Conclusion For pediatric intractable atrial tachycardia originating from the atrial appendage,VATS appendectomy is an ideal surgical approach.VATS appendectomy through an electric cutting and suturing device is safe,effective and more convenient.

关 键 词：心耳切除术 儿童 房性心动过速 电视胸腔镜 

分 类 号：R654.2[医药卫生—外科学]