CAJ | 학술논문

目的：观察并分析室间隔缺损（VSD）封堵术后出现完全性左束支传导阻滞（CLBBB）患儿的临床特点及预后，以指导临床实践。方法回顾性分析2011年1月至2013年12月于广东省人民医院心血管儿科行经皮 VSD 封堵术后出现 CLBBB 的11例患儿的临床资料，根据 CLBBB 出现的时间和临床症状，采用不同的治疗方案，并随访观察其预后。结果11例患儿手术时中位年龄3.9岁（3.4~17.5岁），术后出现 CLBBB的中位时间为2.8个月（1 d ~25.4个月），其中4例为术后1周内出现，1例为术后1周~1个月，6例为术后1个月以上，最迟出现为术后25.4个月。11例患儿中，5例经药物治疗早期心电图恢复正常；3例经药物治疗无效，其中2例行外科手术取出封堵器并修补 VSD，术后1例恢复正常心律，1例转为不完全性右束支传导阻滞，另外1例未行手术取出封堵器，仍为 CLBBB；3例患儿因 CLBBB 出现时间晚（≥6个月）且无临床症状，未予特殊处理。至随访结束，4例患儿心电正常；4例持续存在 CLBBB；1例转为右束支传导阻滞；2例转为正常心电后再次复发 CLBBB，其中1例复发病例出现左心室增大，最后因心功能衰竭死亡。结论 VSD 封堵术后早期及中远期均有可能发生 CLBBB，早期出现的 CLBBB 经及时治疗，可恢复正常心电；持续存在的 CLBBB 可致心肌收缩不同步引起心功能不全。对 VSD 封堵术后出现的 CLBBB 应及时予适当治疗，并长期密切随访。
목적：관찰병분석실간격결손（VSD）봉도술후출현완전성좌속지전도조체（CLBBB）환인적림상특점급예후，이지도림상실천。방법회고성분석2011년1월지2013년12월우광동성인민의원심혈관인과행경피 VSD 봉도술후출현 CLBBB 적11례환인적림상자료，근거 CLBBB 출현적시간화림상증상，채용불동적치료방안，병수방관찰기예후。결과11례환인수술시중위년령3.9세（3.4~17.5세），술후출현 CLBBB적중위시간위2.8개월（1 d ~25.4개월），기중4례위술후1주내출현，1례위술후1주~1개월，6례위술후1개월이상，최지출현위술후25.4개월。11례환인중，5례경약물치료조기심전도회복정상；3례경약물치료무효，기중2례행외과수술취출봉도기병수보 VSD，술후1례회복정상심률，1례전위불완전성우속지전도조체，령외1례미행수술취출봉도기，잉위 CLBBB；3례환인인 CLBBB 출현시간만（≥6개월）차무림상증상，미여특수처리。지수방결속，4례환인심전정상；4례지속존재 CLBBB；1례전위우속지전도조체；2례전위정상심전후재차복발 CLBBB，기중1례복발병례출현좌심실증대，최후인심공능쇠갈사망。결론 VSD 봉도술후조기급중원기균유가능발생 CLBBB，조기출현적 CLBBB 경급시치료，가회복정상심전；지속존재적 CLBBB 가치심기수축불동보인기심공능불전。대 VSD 봉도술후출현적 CLBBB 응급시여괄당치료，병장기밀절수방。
Objective To evaluate the clinical features and prognosis of patients with complete left bundle branch block(CLBBB)following transcatheter device closure of ventricular septal defect(VSD)closure. Methods Clinical feathers of 11 patients with postoperative CLBBB in Department of Pediatric Cardiology,Guangdong General Hospital from January 2011 to December 2013 were collected and reviewed retrospectively. They were treated with dif-ferent protocol based on the appeared time of CLBBB occurrence and clinical symptoms. The patients were followed up, and the prognosis was recorded. Results The median age of 11 patients was 3. 9 years(3. 4 to 17. 5 years old). The median interval of intervention therapy to first attack of CLBBB was 2. 8 months(1 day to 25. 4 months). CLBBB oc-curred within 1 week to 1 month postoperatively in 4 patients,another 1 case suffered from CLBBB between 1 week to 1 month postoperatively,meanwhile 6 cases underwent CLBBB after 6 months postoperatively. The longest term of CLBBB attack postoperatively was 25. 4 months in 1 patient. The electrocardiograms on 5 patients returned to normal by only drug treatment. However,3 patients failed to recover with drug therapy,2 of them undertaken surgical procedure to re-move the occluder associated with VSD repair,1 patient recovered to normal and another converted to incomplete right bundle branch block. One of them refused to undertake surgical procedure and still bothered with persistent CLBBB. Another 3 cases did not receive special treatment due to the later attack of CLBBB(≥6 months)without clinical symp-toms. By the end of observation,the electrocardiogram(ECG)in 4 patients returned to normal,4 patients presented with persistent CLBBB. One patient's ECGs were presented with right bundle branch block. After ECG successfully returning to normal ECG by drug therapy,2 patients relapsed during follow - up,and 1 of them developed to an enlarging left ven-tricle and heart failure which led to death. Conclusions CLBBB may occur in short or long - term after VSD closure. ECG may become normal after early and appropriate treatment postoperatively. Systolic dyssynchrony and cardiac dys-function may be caused by persistent CLBBB. Therefore,patients with CLBBB after VSD closure should be treated ap-propriately without delay,and more frequent and longer follow - ups are required.