中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2013年
7期
598-601
,共4页
罗明尧%王水云%孙宏涛%尹朝华%孙欣%宋云虎%胡盛寿
囉明堯%王水雲%孫宏濤%尹朝華%孫訢%宋雲虎%鬍盛壽
라명요%왕수운%손굉도%윤조화%손흔%송운호%호성수
心肌病,肥厚性%心脏外科手术%心脏传导阻滞
心肌病,肥厚性%心髒外科手術%心髒傳導阻滯
심기병,비후성%심장외과수술%심장전도조체
Cardiomyopathy,hypertrophic%Cardiac surgical procedures%Heart block
目的 评价扩大室间隔肥厚心肌切除术(扩大Morrow术)治疗肥厚型梗阻性心肌病后,并发完全性房室传导阻滞的病例特点及其预防和处理.方法 回顾性分析1996年10月至2011年12月,阜外心血管病医院手术治疗的160例肥厚型梗阻性心肌病患者中并发完全性房室传导阻滞的10例患者的临床资料.其中男6例,女4例,年龄13 ~60(45.4±15.8)岁,左心室流出道(left ventricular outflow tract,LVOT)峰值压差为68 ~ 149(105.1 ±25.9)mm Hg(1 mm Hg =0.133 kPa),术前心电图示5例合并右束支传导阻滞,5例合并其他异常,如房性早搏、心房颤动、室性早搏、ST-T段波形改变、异常Q波等.全组均在全麻低温体外循环下经主动脉切口行扩大Morrow术,同期行二尖瓣置换术2例,二尖瓣置换+冠状动脉旁路术2例.分析患者手术前后的心电图、超声心动图,出院后门诊复查和电话随访结果.结果 10例患者术后均发生完全性房室传导阻滞,围术期死亡2例,死因均为完全性房室传导阻滞合并低心排血量综合征、多器官功能衰竭.存活的8例中,4例行二尖瓣行换瓣术,其余4例的二尖瓣为无反流(2例)、微少量反流(2例),SAM征均消失,术后LVOT压差为0~31(13.6±9.7) mm Hg.该8例患者于扩大Morrow术后6d~7个月置入永久起搏器,未合并其他并发症.随访4 ~72(19.4 ±22.1)个月,1例于术后71个月因起搏器电压低,返院更换起搏器.患者生活质量改善,心功能Ⅰ~Ⅱ级,无远期死亡.结论 完全性房室传导阻滞是扩大Morrow术后的主要并发症,须重视术前心电图异常改变,尤其是右束支传导阻滞.完全性房室传导阻滞一旦发生,应及时安装永久起搏器.
目的 評價擴大室間隔肥厚心肌切除術(擴大Morrow術)治療肥厚型梗阻性心肌病後,併髮完全性房室傳導阻滯的病例特點及其預防和處理.方法 迴顧性分析1996年10月至2011年12月,阜外心血管病醫院手術治療的160例肥厚型梗阻性心肌病患者中併髮完全性房室傳導阻滯的10例患者的臨床資料.其中男6例,女4例,年齡13 ~60(45.4±15.8)歲,左心室流齣道(left ventricular outflow tract,LVOT)峰值壓差為68 ~ 149(105.1 ±25.9)mm Hg(1 mm Hg =0.133 kPa),術前心電圖示5例閤併右束支傳導阻滯,5例閤併其他異常,如房性早搏、心房顫動、室性早搏、ST-T段波形改變、異常Q波等.全組均在全痳低溫體外循環下經主動脈切口行擴大Morrow術,同期行二尖瓣置換術2例,二尖瓣置換+冠狀動脈徬路術2例.分析患者手術前後的心電圖、超聲心動圖,齣院後門診複查和電話隨訪結果.結果 10例患者術後均髮生完全性房室傳導阻滯,圍術期死亡2例,死因均為完全性房室傳導阻滯閤併低心排血量綜閤徵、多器官功能衰竭.存活的8例中,4例行二尖瓣行換瓣術,其餘4例的二尖瓣為無反流(2例)、微少量反流(2例),SAM徵均消失,術後LVOT壓差為0~31(13.6±9.7) mm Hg.該8例患者于擴大Morrow術後6d~7箇月置入永久起搏器,未閤併其他併髮癥.隨訪4 ~72(19.4 ±22.1)箇月,1例于術後71箇月因起搏器電壓低,返院更換起搏器.患者生活質量改善,心功能Ⅰ~Ⅱ級,無遠期死亡.結論 完全性房室傳導阻滯是擴大Morrow術後的主要併髮癥,鬚重視術前心電圖異常改變,尤其是右束支傳導阻滯.完全性房室傳導阻滯一旦髮生,應及時安裝永久起搏器.
목적 평개확대실간격비후심기절제술(확대Morrow술)치료비후형경조성심기병후,병발완전성방실전도조체적병례특점급기예방화처리.방법 회고성분석1996년10월지2011년12월,부외심혈관병의원수술치료적160례비후형경조성심기병환자중병발완전성방실전도조체적10례환자적림상자료.기중남6례,녀4례,년령13 ~60(45.4±15.8)세,좌심실류출도(left ventricular outflow tract,LVOT)봉치압차위68 ~ 149(105.1 ±25.9)mm Hg(1 mm Hg =0.133 kPa),술전심전도시5례합병우속지전도조체,5례합병기타이상,여방성조박、심방전동、실성조박、ST-T단파형개변、이상Q파등.전조균재전마저온체외순배하경주동맥절구행확대Morrow술,동기행이첨판치환술2례,이첨판치환+관상동맥방로술2례.분석환자수술전후적심전도、초성심동도,출원후문진복사화전화수방결과.결과 10례환자술후균발생완전성방실전도조체,위술기사망2례,사인균위완전성방실전도조체합병저심배혈량종합정、다기관공능쇠갈.존활적8례중,4례행이첨판행환판술,기여4례적이첨판위무반류(2례)、미소량반류(2례),SAM정균소실,술후LVOT압차위0~31(13.6±9.7) mm Hg.해8례환자우확대Morrow술후6d~7개월치입영구기박기,미합병기타병발증.수방4 ~72(19.4 ±22.1)개월,1례우술후71개월인기박기전압저,반원경환기박기.환자생활질량개선,심공능Ⅰ~Ⅱ급,무원기사망.결론 완전성방실전도조체시확대Morrow술후적주요병발증,수중시술전심전도이상개변,우기시우속지전도조체.완전성방실전도조체일단발생,응급시안장영구기박기.
Objective To analyze the clinical features,precaution and management of complete heart block (CHB) after transaortic extended septal myectomy operation (extended Morrow procedure) in patients with hypertrophic obstructive cardiomyopathy (HOCM).Methods From October 1996 to December 2011,10[6 men; mean age (45.4 ± 15.8) years,range 13-60 years] out of 160 consecutive HOCM patients underwent extended Morrow procedure developed CHB postoperatively.Their clinical data were retrospectively analyzed.Baseline transthoracic echocardiography showed that the left ventricular outflow tract (LVOT) gradients was from 68 to 149 (105.1 ±25.9) mm Hg (1 mm Hg =0.133 kPa),ECG showed right bundle branch block in 5 patients and atrial fibrillation,atrial premature beats or ST-T segment changes in other 5 patients.Besides extended Morrow procedure,concomitant surgical procedures included mitral valve replacement (MVR) in 2 (2/10) and MVR plus coronary artery bypass grafting in another 2 (2/10) patients.Follow-up data were obtained by subsequent clinic visits in outpatient department and telephone interviews.Results The in-hospital mortality was 20% (these two patients died of low cardiac output syndrome and multiple organs failure).Four patients underwent MVR simultaneously survived the operation.Postoperative echocardiography demonstrated a reduced LVOT gradient[(13.6 ± 9.7) mm Hg,P <0.001].Permanent pacemakers were implanted in all 8 survived patients at 6 days to 7 months after operation.No other severe complications were observed.During follow-up [from 4 to 72 (19.4 ± 22.1) months],there was no death,1 patient readmitted to our center at 71 months post operation to change the pacemaker because of low voltage of previously implanted pacemaker.Physical capacity and quality of life improved significantly post operation in these 8 patients.The NYHA functional class remained at Ⅰ-Ⅱ post operation and during follow up.Conclusions CHB is a severe complication after extended Morrow procedure for patients with HOCM and timely permanent pacemaker implantation is mandatory for patients with post procedure CHB.