Yang Zhou,Xiao Yunbin,Wang Yefeng,et al.Follow-up of complete atrioventricular block after transcatheter closure of perimembranous ventricular septal defect with different occluding devices[J].Journal of Clinical Pediatric Surgery,2019,18(10):878-883.[doi:10.3969/j.issn.1671-6353.2019.10.016]
不同类型封堵器介入封堵膜部室间隔缺损致完全性房室传导阻滞比较研究
- Title:
- Follow-up of complete atrioventricular block after transcatheter closure of perimembranous ventricular septal defect with different occluding devices
- Keywords:
- Heart Defects; Congenital; Heart Septal Defects; Ventricular; Heart Block; Treatment Outcome
- 分类号:
- R541;R318.08
- 摘要:
- 目的 通过比较应用不同类型封堵器介入封堵膜部室间隔缺损（perimembranous ventricular septal defect，pmVSD）致完全性房室传导阻滞（complete atrioventricular block，CAVB）的发生率，探讨CAVB发生原因及处理方法。方法 收集湖南省儿童医院2013年3月至2016年12月行介入封堵治疗的pmVSD患儿临床资料（包括术前评估、术中造影、术后随访、心脏彩超和心电图检查结果等），对接受不同封堵器类型治疗后发生CAVB情况进行比较。结果 本研究共封堵pmVSD 500例，发生CAVB 11例，发生率2.2%；其中对称型VSD封堵器CAVB发生率为1.1%（4/359），偏心型VSD封堵器CAVB发生率为4.2%（5/93），小腰大边型VSD封堵器CAVB发生率为5.4%（2/48）。偏心型和小腰大边型VSD封堵器致CAVB发生率高于对称型VSD封堵器，差异有统计学意义（P<0.05），偏心型VSD封堵器与小腰大边型VSD封堵器致CAVB发生率无明显差别（P>0.05）。发生CAVB的11例患儿均应用糖皮质激素治疗，7例无效，3 d后转外科取出封堵器，其中应用对称型封堵器的3例，偏心型封堵器的1例，小腰大边型封堵器的3例，均在1周内恢复窦性心律，均未安装临时或永久起搏器。结论 偏心型和小腰大边型VSD封堵器封堵pmVSD后CAVB发生率高于等边对称型VSD封堵器，选择偏心型和小腰大边型VSD封堵器封堵pmVSD需严格把握指征。
- Abstract:
- Objective To evaluate the incidence of complete atrioventricular block (CAVB) after transcatheter closure of perimembranous ventricular septal defect (pmVSD) with different occluding devices and explore the causes and interventions of complete atrioventricular block (CAVB).Methods From March 2013 to December 2016,500 children underwent pmVSD closure using different occluding devices.Clinical data,angiographic findings,follow-up records and ECG results were retrospectively analyzed.Results All of them were successfully managed with transcatheter closure.No statistic difference existed in age,gender,timing or occluder size.The overall incidence of CAVB was 2.2%,the incidence of CAVB with symmetric,edge type 4 and decentered occluder were 1.1% (4/359),4.2% (5/93) and 5.4% (2/48) respectively.All CAVB patients recovered after methylprednisolone dosing or occluder removing (symmetric,n=3; edge type 4,n=3; decentered,n=1).Among 11 CAVB cases on glucocorticoids,4 ineffective children were converted into surgery after 3 days.And symmetric (n=3),decentered (n=1) and thin-waist-big-side (n=3) occluders were utilized.Sinus rhythm resumed within 1 week.None required implanting a temporary or permanent pacemaker.Conclusion The incidence of CAVB after implanting an edge type 4 or decentered occluder is higher than symmetric occluder during pmVSD closure.
参考文献/References:
1 中国医师协会心血管内科分会先心病工作委员会.常见先天性心脏病介入治疗中国专家共识二、室间隔缺损介入治疗[J].介入放射学杂志,2011,20(2):87-92.DOI:10.3969/j.issn.1008-794X.2011.02.002. Committee on Congenital Heart Diseases,Internal Medicine Branch of Cardiovascular Diseases,Chinese Physicians’ Association.Interventional treatment of common congenital heart diseases:the common view of Chinese medical experts.Part Two-Interventional treatment of ventricular septal defect[J].J Intervent Radiol,2011,20(2):87-92.DOI:10.3969/j.issn.1008-794X.2011.02.002.
2 中国医师协会儿科医师分会先天性心脏病专家委员会,中华医学会儿科学分会心血管学组,《中华儿科杂志》编辑委员会.儿童常见先天性心脏病介入治疗专家共识[J].中华儿科杂志,2015,53(1):17-24.DOI:10.3760/cma.j.issn.0578-1310.2015.01.004. Expert Committee on Congenital Heart Diseases,Branch of Pediatricians,Chinese Medical Doctor Association; Group of Cardiovascular Medicine,Branch of Pediatrics,Chinese Medical Association; Expert Consensus on Intervention Therapies for Common Pediatric Congenital Heart Disease,Editorial Committee of Chinese Journal of Pediatrics[J].Chin J Pediatr,2015,53(1):17-24.DOI:10.3760/cma.j.issn.0578-1310.2015.01.004.
3 徐东进,孟庆智,葛小蔚,等.小腰大边型封堵器堵闭膜部瘤室间隔缺损的临床研究[J].介入放射学杂志,2014,23(6):470-473.DOI:10.3969/j.issn.1008-794X.2014.06.003. Xu DJ,Meng QZ,Ge XW,et al.Clinical study on interventional occlusion of perimembranous ventricular septal defect with pseudoaneurysm by using thin waist occlude[J].J Intervent Radiol,2014,23(6):470-473.DOI:10.3969/j.issn.1008-794X.2014.06.003.
4 管丽华,周达新,葛均波,等.室间隔缺损(VSD)介入治疗中封堵器的个体化应用[J].复旦学报(医学版),2013,40(2):140-147.DOI:10.3969/j.issn.1672-8467.2013.02.003. Guan LH,Zhou DX,Ge JB,et al.Individualized selection of occluder in interventional treatment of ventricular septal defect(VSD)[J].Fudan Univ J Med Sci,2013,40(2):140-147.DOI:10.3969/j.issn.1672-8467.2013.02.003.
5 郭颖,刘廷亮,余志庆,等.Amplatzer第Ⅱ代血管塞封堵膜周型室间隔缺损的临床应用[J].介入放射学杂志,2014,23(4):284-287.DOI:10.3969/j.issn.1008-794X.2014.04.003. Guo Y,Liu TL,Yu ZQ,et al.The clinical application of Amplatzer vascular plug Ⅱ in treating perimembraneous ventricular septal defects[J].J Intervent Radiol,2014,23(4):284-287.DOI:10.3969/j.issn.1008-794X.2014.04.003.
6 戴汝平,高伟.先天性心脏病与瓣膜病介入治疗[M].沈阳.辽宁科学技术出版社,2007:69-88. Dai RP,Gao W.Intervention therapies for congenital heart diseases and valvular diseases[M].Shenyang,Liaoning Science & Technology Press,2007:69-88.
7 沈晟,贾兵,陈张根,等.经胸杂交封堵技术治疗小儿肌部室间隔缺损18例[J].临床小儿外科杂志,2013,12(2):132-134.DOI:10.3969/j.issn.1671-6353.2013.02.017. Shen S,Jia B,Chen ZG,et al.Treatment experience of hybrid approaches for eighteen children with muscular ventricular septal defects[J].J Clin Ped Sur,2013,12(2):132-134.DOI:10.3969/j.issn.1671-6353.2013.02.017.
8 Butera G,Caminati M,Chessa M,et al.Transcatheter closure of perimembranous ventricular septal defects:early and long-term results[J].J Am Coll Cardiol,2007,50(12):1189-1195.DOI:10.1016/j.jacc.2007.03.068.
9 钟庆华,张智伟,方胜先,等.经导管封堵室间隔缺损术后传导阻滞效果观察[J].实用医学杂志,2015,31(9):1472-1474.DOI:10.3969/j.issn.1006-5725.2015.09.028. Zhong QH,Zhang ZW,Fang SX,et al.Follow-up results of heart conduct block after transcatheter closure of ventricular septal defect surgery[J].The Journal of Practical Medicine,2015,31(9):1472-1474.DOI:10.3969/j.issn.1006-5725.2015.09.028.
10 方臻飞,沈向前,胡信群,等.室间隔缺损介入治疗并发完全性房室传导阻滞临床分析[J].中华心血管病杂志,2006,34(6):495-497.DOI:10.3760/j.issn.0253-3758.2006.06.005. Fang ZF,Shen XQ,Hu XQ,et al.Efficacy analysis for intervention therapy of ventricular septal defects plus complete atrioventricular block[J].Chin J Cardiol,2006,34(6):495-497.DOI:10.3760/j.issn.0253-3758.2006.06.005.
11 付松,周更须,于文文,等.不同类型膜周部室间隔缺损经皮介入封堵术的疗效分析[J].中国微创外科杂志,2013,13(6):524-527.DOI:10.3969/j.issn.1009-6604.2013.06.014. Fu S,Zhou GX,Yu WW,et al.The analysis of the effect of percutaneous interventional occlusion on different types of perimembranous wentricular septal defect[J].Chin J Min Inv Surg,2013,13(6):524-527.DOI:10.3969/j.issn.1009-6604.2013.06.014.
12 刘博,何静,王妍妍,等.室间隔缺损介入治疗术后传导阻滞的观察研究[J].第二军医大学学报,2008,29(11):1404-1406.DOI:10.3724/SP.J.1008.2008.01404. Liu B,He J,Wang YY,et al.Observation of conduction block after interventional treatment of ventricular septal defect[J]. Academic Journal of Second Military Medical University,2008,29 (11):1404-1406.DOI:10.3724/SP.J.1008.2008.01404.
13 姚青,张志辉,钟理,等.儿童膜部窒间隔缺损介入治疗时心脏传导阻滞的防治研究[J].重庆医学,2008,37(23):2703-2705.DOI:1671-8348(2008)23-2703-03. Yao Q,Zhang ZH,Zhong L,et al.Study of heart block in transcatheter closure of perimembranous ventricular septal defect in children[J].Chongqing Medicine,2008,37 (23):2703-2705.DOI:1671-8348(2008)23-2703-03.
14 张莉,冉迅,庄梅.室间隔缺损封堵术后迟发性Ⅲ度房室传导阻滞1例[J].贵阳医学院学报,2016,41(3):369-370.DOI:10.19367/j.cnki.1000-2707.2016.03.036. Zhang L,Ran X,Zhuang M.Delayed Ⅲ degree atrioventricular block after transcatheter closure of ventricular septal defect in 1 cases[J].Journal of Guiyang Medical College,2016,41 (3):369-370.DOI:10.19367/j.cnki.1000-2707.2016.03.036.
15 赵武,李奋,等.膜周部室间隔缺损经导管封堵术后并发迟发性完全性房室传导阻滞2例报告并文献复习[J].临床儿科杂志,2011,29(7):621-625.DOI:10.3969/j.issn.1000-3606.2011.07.005. Zhao W,Li F,Zhou AQ,et al.Late-onset complete atrioventricular block after transcatheter closure of perimembranous ventricular septal defect[J].J Clin Pediatr,2011,29(7):621-625.DOI:10.3969/j.issn.1000-3606.2011.07.005.
16 Walsh MA,Bialkowski J,Szkutnik M,et al.Atrioventricular block after transcatheter closure of perimembranous ventricular septal defects[J].Heart,2006,92(9):1295-1297.DOI:10.1136/hrt.2005.084988.
17 Diab K,Cao QL,Hijazi ZM.Device closure of ventricular septal defects(percutaneous and hybrid)using the Amplataer VSD devices[M].//Hijazi ZM,Feldman T,Cheatham JP,et al.Complications during percutaneous interventions for congenital and structural heart disease.London:Informa Healthcare,2009:175-184.
18 Dumitrescu A,Lane GK,Wilkinson JL,et al.Transcatheter closure of perimembranous ventricular septal defect[J].Heart,2007,93(7):867.DOI:10.1136/hrt.2007.119461.
19 周凯,赵乃琤,秦玉明,等.小儿室间隔缺损术后并发完全性房室传导阻滞8例治疗[J].中华解剖与临床杂志,2016,21(4):354-356.DOI:10.3760/cma.j.issn.2095-7041.2016.04.017. Zhou K,Zhao NC,Qin YM,et al.Treatment of 8 cases with complete atrioventricular block in children after cardiac operation for ventricular septal defect[J].Chin J Anat Clin,2016,21(4):354-356.DOI:10.3760/cma.j.issn.2095-7041.2016.04.017.
20 李青,崔传玉,范洁,等.经胸室间隔缺损封堵术围术期氨基末端脑钠肽前体的变化研究[J].临床小儿外科杂志,2016,15(3):238-240.DOI:10.3969/j.issn.1671-6353.2016.03.010. Li Q,Cui CU,Fan J,et al.Changes of N-terminal probrain natriuretic peptide during perioperative period of mini-invasive occlusion of ventricular septal defect[J].J Clin Ped Sur,2016,15(3):238-240.DOI:10.3969/j.issn.1671-6353.2016.03.010.
21 李江林,徐哲,李渝芬,等.先天性室间隔缺损介入失败后封堵器取出术14例[J].实用儿科临床杂志,2010,25(11):794-797. Li JL,Xu Z,Li YF,et al.Surgical occluder removal after interventional failure in 14 children with congenital ventricular septal defect[J].J Appl Clin Pediatr,2010,25(11):794-797.
相似文献/References:
[1]张泽伟,齐建川,高展,等.改良Carpentier法治疗Ebstein畸形[J].临床小儿外科杂志,2010,9(06):404.
ZHANG Ze wei,QI Jian chuan,GAO Zhan,et al.Modified Carpentier’s repair technique in the treatment of Ebstein’s Anomaly: a Clinical Analysis of 18 Cases.[J].Journal of Clinical Pediatric Surgery,2010,9(10):404.
[2]陈纲,贾兵,陈张根,等.儿童复杂先天性心脏病肺动脉环缩术后二期手术时机的探讨[J].临床小儿外科杂志,2008,7(02):10.
[3]宁岩松,乔彬,王同建,等.小婴儿先天性心脏病术后的呼吸管理[J].临床小儿外科杂志,2008,7(04):0.
[4]袁捷,谷兴琳,姜子菲,等.婴儿先天性心脏病非择期手术81例[J].临床小儿外科杂志,2008,7(04):0.
[5]谢学良,明腾,邹勇,等.209例体重5kg以下婴儿先天性心脏病的外科治疗及围术期处理[J].临床小儿外科杂志,2008,7(06):3.
[6]范庆浩,郑雪梅,黄国金,等.婴幼儿先天性心脏病手术治疗47例[J].临床小儿外科杂志,2007,6(03):15.
[7]梁宗敏,杨进福,胡建国,等.非体外循环下有搏动性双向Glenn术治疗小儿复杂先天性心脏病[J].临床小儿外科杂志,2007,6(04):8.
[8]梅海波. 包裹式自体髂骨移植治疗儿童先天性胫骨假关节的疗效观察[J].临床小儿外科杂志,2011,10(03):163.
[9]孙庆增 史迎春 秦海辉 张凤飞. 双侧发育性髋关节脱位一期Salter骨盆截骨术[J].临床小儿外科杂志,2012,11(02):117.
[10]郭云飞 马耿 葛征. PasseriniGlazel 手术治疗先天性肾上腺皮质增生所致女性假两性畸形[J].临床小儿外科杂志,2012,11(04):287.
[J].Journal of Clinical Pediatric Surgery,2012,11(10):287.
[11]柏松,李晓峰,袁峰,等.单源化手术治疗肺动脉闭锁合并室间隔缺损及重要主肺动脉侧支血管[J].临床小儿外科杂志,2010,9(06):410.
BAI Song,LI Xiao feng,YUAN Feng,et al.Unifocalization repair for pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries.[J].Journal of Clinical Pediatric Surgery,2010,9(10):410.
[12]麻晓鹏,王涛,祖莹,等.肺动脉平滑肌细胞钙含量与先心病肺动脉高压的关联性研究[J].临床小儿外科杂志,2008,7(01):9.
[13]袁峰 李晓峰 柏松 郭健 宋振江 赵宇东 李仲智.体重5kg以下完全性肺静脉异位引流患儿的外科治疗[J].临床小儿外科杂志,2011,10(03):184.
[J].Journal of Clinical Pediatric Surgery,2011,10(10):184.
[14]方炜 丁力 张峰 胡英超 陈雨青. 婴幼儿法乐四联症手术治疗近期疗效的影响因素[J].临床小儿外科杂志,2011,10(06):403.
[J].Journal of Clinical Pediatric Surgery,2011,10(10):403.
[15]柳立平 何萍萍 孔 英 朱丽敏 徐卓明. 先天性心脏病延迟关胸患儿胸骨缝合术前后[J].临床小儿外科杂志,2011,10(06):407.
[J].Journal of Clinical Pediatric Surgery,2011,10(10):407.
[16]闫英群 靖文斌. 低龄儿童法乐四联症根治术中右室流出道疏通的策略[J].临床小儿外科杂志,2011,10(06):414.
[J].Journal of Clinical Pediatric Surgery,2011,10(10):414.
[17]汪力 皮名安 龚立 王涛. 小儿先心病并感染性心内膜炎手术治疗中的体外循环技术[J].临床小儿外科杂志,2011,10(06):417.
[J].Journal of Clinical Pediatric Surgery,2011,10(10):417.
备注/Memo
收稿日期:2018-06-07。
通讯作者:陈智,Email:153673747@qq.com