CAJ | 학술논문

目的总结心脏再同步治疗(CRT)中心脏静脉夹层的发生情况和处理方法,为并发症的防治提供经验.方法选取2001年12月至2012年5月符合CRT适应证的患者348例.心脏静脉逆行造影充分显示心脏静脉各属支,将左心室导线植入靶静脉.观察心脏静脉夹层的发生情况、处理方法和结果.结果 335例患者成功植入CRT,手术成功率为96.3％.共14例出现心脏静脉夹层,发生率为4.02％.8例为轻度夹层,密切观察后成功植入左心室导线；5例为中度夹层,其中4例应用导丝技术成功植入左心室导线,1例患者择期植入左心室导线；另有1例严重夹层,出现心包积液和明显症状,积极对症处理后,择期成功手术.结论 CRT植入术应注意规范、轻柔操作,避免夹层的发生.一旦出现夹层,要根据严重程度选择不同的处理方法,有经验的术者可考虑应用本文所述的直接导丝技术.
목적 총결심장재동보치료(CRT)중심장정맥협층적발생정황화처리방법,위병발증적방치제공경험.방법 선취2001년12월지2012년5월부합CRT괄응증적환자348례.심장정맥역행조영충분현시심장정맥각속지,장좌심실도선식입파정맥.관찰심장정맥협층적발생정황、처리방법화결과.결과 335례환자성공식입CRT,수술성공솔위96.3％.공14례출현심장정맥협층,발생솔위4.02％.8례위경도협층,밀절관찰후성공식입좌심실도선；5례위중도협층,기중4례응용도사기술성공식입좌심실도선,1례환자택기식입좌심실도선；령유1례엄중협층,출현심포적액화명현증상,적겁대증처리후,택기성공수술.결론 CRT식입술응주의규범、경유조작,피면협층적발생.일단출현협층,요근거엄중정도선택불동적처리방법,유경험적술자가고필응용본문소술적직접도사기술.
Objective To provide experience for prevention and treatment of coronary venous dissection by summarizing its occurrence and processing strategy in cardiac resynchronization therapy(CRT).Methods Three hundred and forty-eight patients who met the indications for CRT were enrolled in this studyfrom December 2001 to May 2012.The targeted left ventricular leads were implanted by vein approach,after a coronary sinus angiography was performed.The occurrence,treatment and results of coronary venous dissection were analyzed.Results Fourteen coronary venous dissection were occurred in 348 patients,335 patients received CRT successfully(96.3％).8 of the 14 patients with venous dissection were mild dissection,left ventricular lead was implanted successfully with close observation.The venous dissection was moderate in 5 patients,one of them received left ventricular lead implantation electively,the others who were in stable condition received implantation by percutaneous coronary intervention guide wire technic.The severe coronary venous dissection occurred in one patient with obvious symptoms and pericardial effusion.The patient received CRT electively after actively treatment.Conclusions Coronary venous dissection couldbe prevented by standardized and gently operating.The processing strategy based on the severity of dissection.