起搏导线与心导管缠入Chiari网的识别、预防和处理

目的：回顾性分析起搏电极导线与右心导管缠入Chiari网（Chiari network,CN)的病例，探讨其识别线索，提出预防及处理的原则，方法。通过1178例右心导管检查及1826例永久起搏器植入过程中，起搏电极导线或心导管在右心房内受CN缠阻的情况，对其识别及处理进行分析，并用超声心动图查找病因，病理切片检查CN组织，结果：右心导管缠入CN5例，占0．42％；起搏电极导线缠入CN6例，占0．32％，除1例法洛三联症的右心导管需开胸取出外，其余病例的右心导管及起搏电极导线可用手法拉出，均完整无损，无并发症，结论约在1．5％－3．0％人口中，右心房存在CN，是心导管与起搏电极导线的“陷阱”及时预防及识别可减少或减轻CN缠阻事件的发生，导管与起搏导线大多可用于法拉出。

Recognition, prevention and management of pacing lead and cardiac catheter caught by Chiari network

Objective Cases with pacing lead and cardiac catheter caught by Chiari network was retrospect- tively analyzed, so as to promote recognition, prevention and management of the event. Methods The Chiari net- work catching was diagnosed by two-dimensional echocardiography, and tissues of CN were examined by pathologist. Results During 1 178 cases of cardiac catheterization and 1 826 cases of permanent pacemaker implantation, there were 5 cases of cardiac catheter's catching (0.42% )and 6 cases of pacing lead's catching (0.32%) .Thoractomy was needed to take out the caught catheter in only one case with trilogy of Fallot. While in the others, the caught catheters and leads were pulled out by appropriate manipulation. No impairment of the catheters and leads were seen, so did the patients. Conclusion Chiari network in right atrium occurs in about 1.5%-3% of patients undergoing catheteriza- tion and pacing lead insertion. Early recognition and prevention are beneficial for decreasing the catching events. Most of them could be resolved by manipulation.