封堵器介入治疗儿童继发孔房间隔缺损术后房室传导阻滞分析

探讨应用Amplatzer封堵器 （ASO）介入治疗儿童继发孔房间隔缺损（ASD）术后房室传导阻滞（AVB）的发生率、危险因素及防治措施。方法　1998年3月至2005年12月在广东心血管病研究所心儿科450例继发孔ASD患儿接受ASO封堵术。对术前及术后随访的心电图资料进行回顾性分析，统计AVB的发生率及类型，并分析与AVB发生有关的危险因素及防治措施。结果　共有14例发生各种类型的AVB，发生率为3.1%，分别为Ⅰ度AVB 6例，Ⅱ度AVB 4例，Ⅲ度AVB 4例。所有AVB均发生于术后1～2 d内。14例中12例为术后新出现的AVB，2例术前为Ⅰ度AVB术后发展为Ⅱ度和Ⅲ度AVB（各1例）。统计学分析显示，使用过大ASO及小年龄与术后AVB的发生密切相关。AVB发生后常规应用激素等治疗，4例Ⅲ度AVB实施外科手术取出ASO。AVB绝大多数于短期随访内恢复或好转，未见复发。结论　AVB是应用ASO介入治疗儿童继发孔ASD术后的严重并发症。对年龄较小患儿避免置入过大ASO是降低术后AVB的关键。AVB发生后及早给予内科或外科干预，多可于短期内恢复，术后长期随访十分重要。

Atrioventricular block after transcatheter closure of secundum atrial septal defects using Amplatzer septal occluder in children.

Objective　To determine the incidence， risk factors， prevention and treatment of AVB associated with ASD transcatheter closure using ASO in children. Methods　A total of 450 patients underwent transcatheter ASD closure using ASO from March 1998 to December 2005 in our institution. The median age was 6.3 years （ranging from 2.3 to 14 years） and the median weight was 17.4 kg （ranging from 9 to 44 kg）. Electrocardiographic tracings before procedure and at follow-up visits were reviewed. The risk factors， prevention and treatments of the AVB were analyzed. Results　Fourteen patients developed various AVB （3.1%）， including first degree AVB in 6， second degree AVB in 4 and third degree AVB in 4 patients. All AVBs occurred one to two days after transcatheter occlusure of the ASD. Among 14 patients， new-onset AVBs were found in 12 patients and aggravation of preexisting AVBs was noted in 2 patients. The larger device （ 24±2 vs 19±3mm， P < 0.001） and smaller age（4.3±1.4 vs 7.6±2.3 years，P ＝0.03）were two risk factors for AVB. Corticosteroid was routinely used for all patients with AVB and removal of the device was implemented for 4 patients with third degree AVB. A vast majority of cases resolved or improved spontaneously，with no recurrence at short-term follow-up. Conclusions　AVB remains the severe complication after interventional catheterization for ASDs using ASO. The larger device and smaller age can be associated with the development of AVB. Selection of the proper ASO may be the most effective measure to prevent AVB after transcatheter closure of ASDs for small children. Most of all AVBs can resume within a short time by giving medical or surgery intervention as soon as possible.