经导管室间隔缺损封堵术后传导阻滞的处理及随访

目的随访经导管室间隔缺损(VSD)封堵术后并发的传导阻滞，探讨其发生机制及预后。方法2002 06—2005 07山东省立医院小儿心脏科经导管介入治疗89例VSD患儿，对临床资料、心电图、心脏超声、心血管造影资料及随访结果进行分析。结果89例患儿应用Amplatzer膜部VSD封堵器67例，国产对称型VSD封堵器20例，Amplatzer导管封堵器1例，pfm弹簧圈1例。术后出现间歇性完全性房室传导阻滞2例次，其中1例应用临时起搏器治疗，分别于术后第10天、第20天恢复窦性心律；完全性左束支阻滞3例次，完全性右束支阻滞3例次，左前半分支阻滞2例次，不完全性右束支阻滞5例次，加速性交界性心律合并完全性左束支阻滞1例次。结论传导阻滞是VSD介入治疗术后的常见并发症，经治疗预后良好，及时发现、及时处理是诊疗的关键，对心内传导系统远期的影响仍需进一步评价。

Treatments and follow up studies of conduction system abnormalities after transcatheter closure of ventricular septal defects.

AbstractObjectiveDo follow up investigations on the conduction system abnormalities after transcatheter closure of ventricular septal defects,and assess the clinical results.MethodsA total of 89 patients with VSD underwent transcatheter occlusion.Follow up studies including chest X ray,electrocardiogram (ECG) and transthoracic echocardiography (TTE) were done after the procedure.ResultsAmong 89 cases,Amplatzer membranous VSD occluders were used in 67 patients,home made symmetric VSD occluders were used in 20 patients,Amplazter duct occluder and pfm coil were used in one case,respectively.ECG follow up studies showed that 2 patients developed transient complete atrioventricular block after closure,and both recovered after temporary pace maker implantation and/or transvenous use of desamethasone.And there were 3 cases of complete left bundle branch block,3 cases of complete right bundle branch block,5 cases of incomplete right bundle branch block,2 cases of left anterior hemiblock and 1 case of accelerated atrio ventricular junctional tachycardia combined with complete left bundle branch block happened after closure.ConclusionConduction blockades are the common complications after transcatheter closure of VSD,most of them having benign courses.To be noted and treated in time is the key points.Further follow up studies are required to document the long term efficacy and safety,especially the effect on the intracardiac conduction.