中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2009年
11期
990-993
,共4页
宋治远%李永华%柴虹%李华康%姚青%钟理%景涛%冉擘力%仝识非%刘建平
宋治遠%李永華%柴虹%李華康%姚青%鐘理%景濤%冉擘力%仝識非%劉建平
송치원%리영화%시홍%리화강%요청%종리%경도%염벽력%동식비%류건평
室间隔缺损%心脏导管插入术%心脏传导阻滞%随访研究
室間隔缺損%心髒導管插入術%心髒傳導阻滯%隨訪研究
실간격결손%심장도관삽입술%심장전도조체%수방연구
Heart septal defect%ventricular%Heart catheterization%Heart block%Follow-up studies
目的 探讨室间隔缺损(VSD)介入治疗围术期发生心脏传导阻滞对患者远期预后的影响.方法 以VSD介入治疗术中或术后1周内发生完全性左右束支传导阻滞(CLBBB、CRBBB)、不完全性左右束支传导阻滞(ILBBB、IRBBB)及一度、二度、三度房室传导阻滞(AVB)患者为研究对象,分别于术后1、6个月及1、2、3、4、5年各随访1次,复查心电图、动态心电图及超声心动图,观察各型心脏传导阻滞的恢复变化情况.结果 共43例发生不同类型心脏传导阻滞,术中发生26例(CLBBB 4例、CRBBB 5例、ILBBB 2例、IRBBB 10例、三度AVB 5例),术后发生17例(CLBBB 5例、CRBBB 2例、一度AVB 3例、二度Ⅰ型AVB 1例、二度AVB 6例).随访1.0～5.0(2.6±1.3)年,33例(76.7%)于出院时完全恢复正常,术后1、6个月时心电图完全正常者分别为86.1%(37/43)和95.4%(41/43).术后2年仍有CLBBB及CRBBB者各1例.所有患者心脏趟声检查均未见心腔异常增大及心功能不全表现.结论 VSD围术期发生的心脏传导阻滞,经积极恰当治疗,95%以上可完全恢复正常,不影响VSD介入治疗的远期疗效.
目的 探討室間隔缺損(VSD)介入治療圍術期髮生心髒傳導阻滯對患者遠期預後的影響.方法 以VSD介入治療術中或術後1週內髮生完全性左右束支傳導阻滯(CLBBB、CRBBB)、不完全性左右束支傳導阻滯(ILBBB、IRBBB)及一度、二度、三度房室傳導阻滯(AVB)患者為研究對象,分彆于術後1、6箇月及1、2、3、4、5年各隨訪1次,複查心電圖、動態心電圖及超聲心動圖,觀察各型心髒傳導阻滯的恢複變化情況.結果 共43例髮生不同類型心髒傳導阻滯,術中髮生26例(CLBBB 4例、CRBBB 5例、ILBBB 2例、IRBBB 10例、三度AVB 5例),術後髮生17例(CLBBB 5例、CRBBB 2例、一度AVB 3例、二度Ⅰ型AVB 1例、二度AVB 6例).隨訪1.0～5.0(2.6±1.3)年,33例(76.7%)于齣院時完全恢複正常,術後1、6箇月時心電圖完全正常者分彆為86.1%(37/43)和95.4%(41/43).術後2年仍有CLBBB及CRBBB者各1例.所有患者心髒趟聲檢查均未見心腔異常增大及心功能不全錶現.結論 VSD圍術期髮生的心髒傳導阻滯,經積極恰噹治療,95%以上可完全恢複正常,不影響VSD介入治療的遠期療效.
목적 탐토실간격결손(VSD)개입치료위술기발생심장전도조체대환자원기예후적영향.방법 이VSD개입치료술중혹술후1주내발생완전성좌우속지전도조체(CLBBB、CRBBB)、불완전성좌우속지전도조체(ILBBB、IRBBB)급일도、이도、삼도방실전도조체(AVB)환자위연구대상,분별우술후1、6개월급1、2、3、4、5년각수방1차,복사심전도、동태심전도급초성심동도,관찰각형심장전도조체적회복변화정황.결과 공43례발생불동류형심장전도조체,술중발생26례(CLBBB 4례、CRBBB 5례、ILBBB 2례、IRBBB 10례、삼도AVB 5례),술후발생17례(CLBBB 5례、CRBBB 2례、일도AVB 3례、이도Ⅰ형AVB 1례、이도AVB 6례).수방1.0～5.0(2.6±1.3)년,33례(76.7%)우출원시완전회복정상,술후1、6개월시심전도완전정상자분별위86.1%(37/43)화95.4%(41/43).술후2년잉유CLBBB급CRBBB자각1례.소유환자심장쟁성검사균미견심강이상증대급심공능불전표현.결론 VSD위술기발생적심장전도조체,경적겁흡당치료,95%이상가완전회복정상,불영향VSD개입치료적원기료효.
Objective To investigate the prognostic impact of heart block during the transcatheter closure of ventricular septal defect (VSD). Methods Forty three patients developed complete left or right bundle branch block (CLBBB, CRBBB), incomplete left or right bundle branch block (ILBBB, IRBBB), and atrioventricular block (AVB) during and within 1 week post procedure were followuped at 1, 6, 12, 24, 36, 48 and 60 months post procedure. Electrocardiogram, dynamic electrocardiogram and transthoracic echocardiography were made. Results Bundle branch block and atrioventricular block were detected in 26 patients (CLBBB n=4, CRBBB n=5, ILBBB n=2, IRBBB n=10 and third-degree AVB n=5) during the transcatheter closure of VSD, and in 17 patients (CLBBB n=5, CRBBB n=2, first-degree AVB n=3, second-degree Ⅰ-type AVB n=1 and third-degree AVB n=6) within I week post procedure, Heart block disappeared in 33 patients (76.7%) before discharge, in 37 patients (86.1%) at 1 month and in 41 patients (95.4%) at 6 months post procedure. CLBBB or CRBBB was seen in two cases at 24 months after closure. There was no heart failure and serious cardiac dilatation during follow up. Conclusion The heart block occurred during the periprocedure period of transcatheter closure of VSD was a benign phenomenon without prognostic importance.
