室间隔缺损介入术后完全性左束支传导阻滞9例分析

发布时间：2018-07-17 02:15

【摘要】：目的探讨室间隔缺损(VSD)介入术后并发完全性左束支传导阻滞(CLBBB)的高危因素及预后。方法回顾2010年4月至2015年12月南京医科大学附属儿童医院心脏中心VSD介入术后并发CLBBB 9例患儿的一般资料及随访结果,分析9例患儿年龄、VSD及封堵器类型、术后CLBBB出现时间及转归、左心室舒张末期内径(LVEDD)及左心室射血分数(LVEF)变化情况。结果年龄:除1例年龄偏大外,其余8例均在5岁以内。VSD及封堵器类型:膜周型VSD伴假性膨出瘤3例,嵴内型VSD 6例;1例选择对称型封堵器,2例选择小腰大边型封堵器,6例选择偏心型封堵器。术后CLBBB出现时间及转归:术后3 d内8例、术后1个月1例;8例术后早期并发CLBBB患儿在住院期间经药物治疗后有4例恢复正常,其中2例术后1个月复查,再次出现CLBBB;1例术后1个月开始出现CLBBB的患儿接受外科手术后,次日CLBBB恢复正常。LVEDD及LVEF变化:2例分别于术后6、12个月出现不同程度LVEDD增大,其余7例未出现明显LVEDD增大,9例均未出现LVEF下降。结论VSD介入治疗应严格遵循专家共识、规范化操作;对低龄VSD患儿介入封堵治疗应谨慎;在保证封堵治疗效果的前提下,尽量选择对称型封堵器。VSD介入术后并发CLBBB近期预后良好,但部分病例远期出现LVEDD增大,对于术后出现CLBBB病例,应严格长期随访。
[Abstract]:Objective to investigate the risk factors and prognosis of complete left bundle branch block (CLBBB) after interventional surgery for ventricular septal defect (VSD). Methods from April 2010 to December 2015, the general data and follow-up results of 9 children with CLBBB after VSD intervention in heart center of Children's Hospital affiliated to Nanjing Medical University were reviewed. The age of 9 children and the type of occluder were analyzed. The time and outcome of CLBBB, left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) were observed. Results Age: except for 1 case with older age, 8 cases were within 5 years old. VSD and occluder type: perimembranous VSD with pseudocele in 3 cases. In 6 cases of intracristal VSD, 1 case chose symmetrical occluder, 2 cases chose small waist and big side type occluder, 6 cases chose eccentric type occluder. The time and outcome of CLBBB: 8 cases within 3 days after operation, 1 case with CLBBB in 1 month and 8 cases with CLBBB in early postoperative period, 4 cases returned to normal after medical treatment during hospitalization, 2 cases were reexamined 1 month after operation. After surgery, the CLBBB returned to normal level in 1 case of CLBBB, and the changes of LVEDD and LVEF in 2 cases were increased at 6 months and 12 months after operation, respectively. No significant increase of LVEDD was found in the other 7 cases, and no LVEF decreased in 9 cases. Conclusion the intervention therapy of VSD should strictly follow the common understanding of experts, standardize the operation, be careful in the treatment of young VSD children, and ensure the effect of blocking therapy. As far as possible, symmetrical occluder. VSD interventional surgery complicated with CLBBB had a good prognosis in the near future, but LVEDD was increased in long term in some cases, and long-term follow-up should be strict for CLBBB cases after operation.
【作者单位】：南京医科大学附属儿童医院心血管内科;南京医科大学附属儿童医院超声科;
【分类号】：R725.4

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