【摘要】：目的探討室間隔缺損(VSD)介入術后并發(fā)完全性左束支傳導阻滯(CLBBB)的高危因素及預后。方法回顧2010年4月至2015年12月南京醫(yī)科大學附屬兒童醫(yī)院心臟中心VSD介入術后并發(fā)CLBBB 9例患兒的一般資料及隨訪結果,分析9例患兒年齡、VSD及封堵器類型、術后CLBBB出現(xiàn)時間及轉歸、左心室舒張末期內徑(LVEDD)及左心室射血分數(shù)(LVEF)變化情況。結果年齡:除1例年齡偏大外,其余8例均在5歲以內。VSD及封堵器類型:膜周型VSD伴假性膨出瘤3例,嵴內型VSD 6例;1例選擇對稱型封堵器,2例選擇小腰大邊型封堵器,6例選擇偏心型封堵器。術后CLBBB出現(xiàn)時間及轉歸:術后3 d內8例、術后1個月1例;8例術后早期并發(fā)CLBBB患兒在住院期間經藥物治療后有4例恢復正常,其中2例術后1個月復查,再次出現(xiàn)CLBBB;1例術后1個月開始出現(xiàn)CLBBB的患兒接受外科手術后,次日CLBBB恢復正常。LVEDD及LVEF變化:2例分別于術后6、12個月出現(xiàn)不同程度LVEDD增大,其余7例未出現(xiàn)明顯LVEDD增大,9例均未出現(xiàn)LVEF下降。結論VSD介入治療應嚴格遵循專家共識、規(guī)范化操作;對低齡VSD患兒介入封堵治療應謹慎;在保證封堵治療效果的前提下,盡量選擇對稱型封堵器。VSD介入術后并發(fā)CLBBB近期預后良好,但部分病例遠期出現(xiàn)LVEDD增大,對于術后出現(xiàn)CLBBB病例,應嚴格長期隨訪。
[Abstract]:Objective to investigate the risk factors and prognosis of complete left bundle branch block (CLBBB) after interventional surgery for ventricular septal defect (VSD). Methods from April 2010 to December 2015, the general data and follow-up results of 9 children with CLBBB after VSD intervention in heart center of Children's Hospital affiliated to Nanjing Medical University were reviewed. The age of 9 children and the type of occluder were analyzed. The time and outcome of CLBBB, left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) were observed. Results Age: except for 1 case with older age, 8 cases were within 5 years old. VSD and occluder type: perimembranous VSD with pseudocele in 3 cases. In 6 cases of intracristal VSD, 1 case chose symmetrical occluder, 2 cases chose small waist and big side type occluder, 6 cases chose eccentric type occluder. The time and outcome of CLBBB: 8 cases within 3 days after operation, 1 case with CLBBB in 1 month and 8 cases with CLBBB in early postoperative period, 4 cases returned to normal after medical treatment during hospitalization, 2 cases were reexamined 1 month after operation. After surgery, the CLBBB returned to normal level in 1 case of CLBBB, and the changes of LVEDD and LVEF in 2 cases were increased at 6 months and 12 months after operation, respectively. No significant increase of LVEDD was found in the other 7 cases, and no LVEF decreased in 9 cases. Conclusion the intervention therapy of VSD should strictly follow the common understanding of experts, standardize the operation, be careful in the treatment of young VSD children, and ensure the effect of blocking therapy. As far as possible, symmetrical occluder. VSD interventional surgery complicated with CLBBB had a good prognosis in the near future, but LVEDD was increased in long term in some cases, and long-term follow-up should be strict for CLBBB cases after operation.
【作者單位】： 南京醫(yī)科大學附屬兒童醫(yī)院心血管內科;南京醫(yī)科大學附屬兒童醫(yī)院超聲科;
【分類號】：R725.4

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