膜周部室间隔缺损介入治疗术后早期心律失常危险因素的探讨

Risk factors for early arrhythmias post transcatheter closure of perimembranous ventricular septal defects

目的探讨影响膜周部室间隔缺损(PVSD)介入治疗术后早期心律失常的危险因素。方法 2002年8月至2006年2月用介入法治疗358例 PVSD 患者,男性161例,女性197例,年龄3～54(10.9±8.1)岁,体重12～90(32.8±17.2)kg。左室造影测量 PVSD 左室面直径2～18(6.5±3.1)mm,右室面直径2～12(4.2±2.3)mm;195例合并膜部膨出瘤。358例均具备介入治疗指征,共置人封堵器358枚,其直径4～18(8.1±2.5)mm,其中偏心型封堵器140枚,对称型封堵器218枚。术后每天记录12导联心电图,持续7天,系统分析影响 PVSD 封堵术后早期心律失常10余种危险因素。结果所有病例的 PVSD 均获得完全关闭。术后早期发生各种心律失常135例,发生率为37.7%,其中严重心律失常23例,发生率为6.4%。统计学处理后,PVSD 封堵后早期心律失常的发生率与封堵器型号、类型、PVSD 与三尖瓣隔瓣的距离和是否合并有膜部膨出瘤密切相关。结论封堵器型号大[≥(8.6±2.7)mm]、偏心型封堵器、PVSD 与三尖瓣隔瓣距离≤3 mm 及合并有膜部膨出瘤是 PVSD 介入治疗术后早期心律失常发生的危险因素。

Objective To analyze the risk factors for early arrhythmias after transcatheter closure of perimembranous ventricular septal defect（PVSD）. Methods A total of 358 patients [ 161 males, aged from 3 to 54, mean （ 10. 9 ±8.1 ） years, body weight from 12 to 90, mean （ 32. 8 ± 17. 2 ） kg ] who underwent transcatbeter closure of PVSD from August 2002 to February 2006 were included in this retrospective analysis. Electrocardiogram was performed daily after transcatheter closure for seven days. Relationships between arrhythmias and those risk factors such as the defect characteristics and the device size and types were explored by logistic regression analysis. Left ventriculography showed 195 out of 358 patients with PVSD were complicated with membranous aneurism. The PVSD diameter ranged from 2 to 18 （6. 5±3.1 ） mm in left ventricular side and from 2 to 12 （4. 2 ± 2. 3 ） mm in right ventricular side. A total of 140 nonsymmetrical and 218 symmetrical occluders with diameter 4 to 18 （8. 1±2. 5） mm were used to close those defects. Results Procedure was successful in all patients. Early arrhythmias after transcatheter closure of PVSD were observed in 135 （ 37.7% ） patients and serious cardiac arrhythmias in 23 （ 6. 4% ） patients. The early arrhythmias after transcatheter closure of PVSD were significantly correlated with device size [ ≥ （8.6 ± 2.7 ） mm ] and type （ nonsymmetrical device） , the span between the defect and tricuspid （ ≤3 mm）, and the presence of aneurism. Conclusion Larger device size, nonsymmetrical device, narrow span between the defect and tricuspid and the presence of aneurism are the risk factors for early arrhythmias after transcatheter closure of PVSD.