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目的心律失常是经导管封堵膜周部室间隔缺损术后的常见并发症,不仅影响术后心功能的恢复,而且直接关系到预后。分析18岁以内患者膜周部室间隔缺损经导管封堵术后早期心律失常及其危险因素,以期降低术后心律失常的发生率。方法2002年6月—2004年6月,89例膜周部室间隔缺损患者根据家长意愿接受了经导管应用Amplatzer装置及国产封堵器进行堵塞。80例应用AGA公司制造的Amlatzer膜周部室间隔缺损封堵器,9例应用国产封堵装置,术后定期行心脏超声及心电图检查。结果89例膜周部室间隔缺损封堵术均获成功。11例术后5d内发生了不同类型的传导阻滞,发生率为12%,分别为Ⅰ°房室传导阻滞1例,Ⅲ°房室传导阻滞1例,左前分支阻滞5例,不完全(部分)性右束支传导阻滞4例,完全性右束支传导阻滞3例,其中3例并发两种传导阻滞。分析本组心律失常的影响因素,发现:(1)室间隔缺损上缘距主动脉右冠瓣距离<3mm;(2)室间隔缺损直径≥8mm,封堵器直径≥10mm;(3)穿刺成功后动脉静脉(A-V)轨道建立时间≥60min及术中pH值<7·35与心律失常密切相关。结论心律失常是膜周部室间隔缺损封堵术后早期严重的并发症;严格选择手术适应证、缩短手术操作时间、防止酸中毒是降低膜周部室间隔缺损介入封堵术后心律失常发生率的有效措施。
The purpose of arrhythmia is a common complication after transcatheter closure of perimembranous ventricular septal defect, not only affect the recovery of postoperative cardiac function, but also directly related to the prognosis. Analysis of 18-year-old patients with perimembranous ventricular septal defect after catheterization of early arrhythmia and risk factors in order to reduce the incidence of postoperative arrhythmia. Methods From June 2002 to June 2004, 89 patients with perimembranous ventricular septal defect received the Amplatzer device and domestic occluder occlusion according to their parents’ wishes. Eighty patients were treated with Amlatzer perimembranous ventricular septal defect occluder manufactured by AGA Corporation. Nine patients were treated with homemade occlusion device. Cardiac echocardiography and electrocardiogram were performed regularly. Results 89 cases of perimembranous ventricular septal defect closure were successful. Eleven patients had different types of conduction block within 5 days after operation. The incidence rate was 12%. They were Ⅰ degree atrioventricular block, 1 degree Ⅲ atrioventricular block, 5 left anterior branch block, Incomplete (partial) right bundle branch block in 4 cases, complete right bundle branch block in 3 cases, of which 3 cases complicated by two types of conduction block. Analysis of the factors affecting the arrhythmia in this group, found that: (1) the superior margin of the ventricular septal defect from the right coronary artery aortic valve distance <3mm; (2) ventricular septal defect diameter ≥ 8mm, occluder diameter ≥ 10mm; (3) Successfully established arteriovenous (AV) orbital time ≥ 60min and intraoperative pH value <7 · 35 and arrhythmia are closely related. Conclusions Arrhythmia is a serious complication in the early stage after transcatheter closure of perimembranous ventricular septal defect. Strict indications of surgical indications, shorter operation time and prevention of acidosis are the risk factors of arrhythmia after transcatheter closure of perimembranous ventricular septal defect Effective measures