心脏再同步化治疗术中所遇问题及并发症的处理

目的介绍心脏再同步化治疗(CRT)手术中所遇的问题及并发症处理。方法回顾分析单中心CRT植入过程中所遇问题及并发症的发生与相应处理。结果共有4例患者出现问题或并发症,其中男3例、女1例。例1冠状静脉窦难以寻找,而改为右室双部位起搏;例2术中发生冠状静脉窦静脉夹层;例3术中突发急性左心衰竭,左室电极导线难以固定而留置经皮冠状动脉腔内成形术(PTCA)钢丝;例4左室电极导线置于心中静脉,在右房、右室电极植入时反复出现空气栓塞。结论 CRT术前应充分抗心力衰竭治疗,术中避免静脉夹层及空气栓塞,必要时右室双部位起搏,难以固定时留置PTCA钢丝于靶静脉内是可行的。

The related difficulties and management of procedural complications of cardiac resynchronization therapy

Objective To introduce the difficulties during cardiac resynchronization therapy(CRT) and its management of related procedural complications.Methods A single center retrospective analysis to introduce the management of left ventricular(LV) lead placement difficulties and related procedural complications during CRT.Results Four patients developed procedural complications,including three males and one female.Case 1 had difficulty in locating the coronary sinus ostium and right ventricular bifocal pacing was done instead.Case 2 developed coronary sinus dissection.Acute left heart failure occurred in case 3 during procedure and a PTCA wire was retained because the fixing of LV lead was impossible.In case 4,recurrent aeroembolism occurred while placing right atrial and right ventricular leads after LV lead was fixed in middle cardiac vein.Conclusion Cardiac function should be improved sufficiently before CRT.Dissection and aeroembolism should be paid attention.Right ventricular bifocal pacing can be applied when necessary.A PTCA wire retained in target vein may be an alternative when fixing is impossible.Chinese Journal of Cardiac Pacing and Electrophysiology,2012,26(3):208-210]