CAJ | 학술논문

目的报道儿童先天性心脏病室间隔缺损(VSD)术后远期出现的心房内折返性心动过速(IART)的电生理标测及导管消融疗效.方法 8例患儿(男、女各4例),平均年龄(7.1±4.1)岁,VSD术后1～5年发生持续性IART,8例均有左心室扩大,其中5例合并慢性心力衰竭.行心房电生理标测,部分应用三维标测( EnSite NavX)技术,标测折返环的关键峡部并行导管消融.结果 8例均自发IART,折返环关键部位分布:6例位于三尖瓣环峡部,1例于右心房界嵴至下腔静脉间,1例于三尖瓣环9点位置至界嵴间.所有(100％)患儿手术即刻成功,无并发症.平均随访(25.2±16.5)个月,2例复发,其中1例再次消融成功,总成功率7/8( 87.5％).左心室大小及射血分数均明显好转.结论儿童VSD术后IART机制多为三尖瓣环-下腔静脉峡部依赖型心房扑动,可经导管消融治愈或明显改善.三维标测技术能准确快速定位折返环的电生理峡部并指导消融,显著减少曝光时间.
목적 보도인동선천성심장병실간격결손(VSD)술후원기출현적심방내절반성심동과속(IART)적전생리표측급도관소융료효.방법 8례환인(남、녀각4례),평균년령(7.1±4.1)세,VSD술후1～5년발생지속성IART,8례균유좌심실확대,기중5례합병만성심력쇠갈.행심방전생리표측,부분응용삼유표측( EnSite NavX)기술,표측절반배적관건협부병행도관소융.결과 8례균자발IART,절반배관건부위분포:6례위우삼첨판배협부,1례우우심방계척지하강정맥간,1례우삼첨판배9점위치지계척간.소유(100％)환인수술즉각성공,무병발증.평균수방(25.2±16.5)개월,2례복발,기중1례재차소융성공,총성공솔7/8( 87.5％).좌심실대소급사혈분수균명현호전.결론 인동VSD술후IART궤제다위삼첨판배-하강정맥협부의뢰형심방복동,가경도관소융치유혹명현개선.삼유표측기술능준학쾌속정위절반배적전생리협부병지도소융,현저감소폭광시간.
Objective This study aimed to investigate the effects of electrophysiological study(EPS) and radiofrequency (RF) catheter ablation of intra-atrial reentrant tachycardia (IART) after repairing the congenital ventricular septal defect (VSD) in pediatrics.Methods Eight children (4 boys,and 4 girls,mean age 7.1 ± 4.1 years),who experienced incessant IART 1-5 years after VSD surgery,underwent EPS and RF ablation.All children had dilated left ventricle ( LV),and 5 of 8 demonstrated severely LV dilation and congestive heart failure before ablation.RF energy was delivered to the critical isthmus of the reentry circuit of IART.Results All children have spontaneous AT at the beginning of the procedure.All of the IARTs was macro-reentrant mechanism.The critical isthmus was located at the isthmus between inferior vena cava(IVC)-tricuspid valve annulus (TVA)in 6,between the crista teminalis(CT)and IVC in 1,and between CT and 9 o' clock of TVA in 1.RF ablation was acutely successful in 8 ( 100％ ) patients without any complications.During a follow-up period of (25.2± 16.5 )months,2 children had recurrence of AT,and 1 had the successfully second procedure.The total success rate was 7/8 ( 87.5％ ).The children with dilated LV before ablation had improved LV diameter and function.Conclusion The mechanism of IART after repair of VSD is mainly the atrial flutter using the isthmus between IVC-TVA,and can be cured by RF ablation.The 3-dimensional mapping technique helps to accurately and quickly define the isthmus of reentrant circuit and guide ablation.