室间隔缺损介入治疗围术期发生心脏传导阻滞患者的随访研究

目的 探讨室间隔缺损(VSD)介入治疗围术期发生心脏传导阻滞对患者远期预后的影响.方法 以VSD介入治疗术中或术后1周内发生完全性左右束支传导阻滞(CLBBB、CRBBB)、不完全性左右束支传导阻滞(ILBBB、IRBBB)及一度、二度、三度房室传导阻滞(AVB)患者为研究对象,分别于术后1、6个月及1、2、3、4、5年各随访1次,复查心电图、动态心电图及超声心动图,观察各型心脏传导阻滞的恢复变化情况.结果 共43例发生不同类型心脏传导阻滞,术中发生26例(CLBBB 4例、CRBBB 5例、ILBBB 2例、IRBBB 10例、三度AVB 5例),术后发生17例(CLBBB 5例、CRBBB 2例、一度AVB 3例、二度Ⅰ型AVB 1例、二度AVB 6例).随访1.0～5.0(2.6±1.3)年,33例(76.7%)于出院时完全恢复正常,术后1、6个月时心电图完全正常者分别为86.1%(37/43)和95.4%(41/43).术后2年仍有CLBBB及CRBBB者各1例.所有患者心脏趟声检查均未见心腔异常增大及心功能不全表现.结论 VSD围术期发生的心脏传导阻滞,经积极恰当治疗,95%以上可完全恢复正常,不影响VSD介入治疗的远期疗效.

Prognostic impact of heart block during transcatheter closure of ventricular septal defect

Objective To investigate the prognostic impact of heart block during the transcatheter closure of ventricular septal defect (VSD). Methods Forty three patients developed complete left or right bundle branch block (CLBBB, CRBBB), incomplete left or right bundle branch block (ILBBB, IRBBB), and atrioventricular block (AVB) during and within 1 week post procedure were followuped at 1, 6, 12, 24, 36, 48 and 60 months post procedure. Electrocardiogram, dynamic electrocardiogram and transthoracic echocardiography were made. Results Bundle branch block and atrioventricular block were detected in 26 patients (CLBBB n=4, CRBBB n=5, ILBBB n=2, IRBBB n=10 and third-degree AVB n=5) during the transcatheter closure of VSD, and in 17 patients (CLBBB n=5, CRBBB n=2, first-degree AVB n=3, second-degree Ⅰ-type AVB n=1 and third-degree AVB n=6) within I week post procedure, Heart block disappeared in 33 patients (76.7%) before discharge, in 37 patients (86.1%) at 1 month and in 41 patients (95.4%) at 6 months post procedure. CLBBB or CRBBB was seen in two cases at 24 months after closure. There was no heart failure and serious cardiac dilatation during follow up. Conclusion The heart block occurred during the periprocedure period of transcatheter closure of VSD was a benign phenomenon without prognostic importance.