膜部室间隔缺损介入治疗与外科手术后早中期心律失常的对比分析

Short- and mid-term outcomes of arrhythmia after transcatheter and surgical closure of membranous ventricular septal defects:a comparative analysis

目的评价膜部室间隔缺损(VSD)治疗后心律失常的发生率和预后。方法对比分析2002年8月至2006年2月采用介入治疗膜部 VSD 患者358例(介入组)外科治疗手术组50例(手术组),治疗后和出院时的心电图心律失常改变,并对患者进行1、3、6和12个月连续随访。结果两组住院中除束支阻滞外,其他心律失常均在出院前消失。出院时介入组完全性右束支阻滞16例(4.5%),不完全性右束支阻滞36例(10.1%),左前半阻滞10例(2.8%),不完全性右束支阻滞并左前半阻滞6例(1.7%),完全性右束支阻滞并左前半阻滞2例(0.6%);而外科手术组完全性右束支阻滞和不完全性右束支阻滞分别为13例(26%)和14例(28%),显著高于介入组;随访1年时,介入组完全性右束支阻滞(3.3%)、不完全性右束支阻滞(3.3%)、完全性右束支阻滞并左前半阻滞(1.7%)和Ⅲ度房室传导阻滞(0.56%)明显得到改善,而外科手术组则无改善。介入组随访到180例,外科手术组随访50例。两组患者的性别、年龄、体重、膜部 VSD 大小、合并膜部膨出瘤的比例差异均无统计学意义(均 P>0.05)。结论两组治疗的临床效果一致,但是介入治疗比外科手术更安全;介入治疗产生的不完全性右束支阻滞和左前半阻滞,多在术后6～12个月消失,而完全性右束支阻滞或完全性右束支阻滞并左前半阻滞则需长期随访。

Objective To evaluate the short- and mid-term outcomes of arrhythmia in patients undergoing transcatheter and surgical closure of membraneous ventricular septal defect （ VSD ）. Methods 358 VSD patients, 161 male and 197 female, aged （11 _＋ 8） , underwent transcatheter closure and 50 sex, age, body weight, size of membranous VSD, and percentage of complicated membranous aneurysm-matched VSD patients underwent surgical closure. Electrocardiography was conducted 1, 3, 6, and 12 months after VSD closure. Results Except bundle branch block other kinds of arrhythmia were resolved in all the patients prior to discharge. The arrhythmias occurring in the patients who underwent transcatheter closure of VSD included complete right bundle branch block （CRBBB ,4 5% ） , incomplete right bundle branch block （IRBBB, 10. 1% ） , left anterior fascicular block （ LAFB, 2. 8% ） , IRBBB complicated with LAFB （ 1.7% ） , and CRBBB complicated with LAFB （0.6%） , while in the patients who underwent surgical closure included CRBBB （26%） and IRBBB （28%）. At the end of 12 months of follow-up, of the 180 patients who had undergone interventional therapy 6 showed CRBBB （3.3%） ,6 showed IRBBB （3.3%） , 3 showed CRBBB complicated with LAFB （1.7%.） and one showed third degree auriculo-ventricular block （0.56%） s, however, no significant change in the ECG findings occurred in the patients who had undergone surgical closure. Conclusion Transcatheter occlusion of membraneous VSD is safer than surgical closure. IRBBB and LAFB caused by interventional therapy are benign, the majority of which may resolve itself 6-12 months after the procedure. However, CRBBB and CRBBB complicated with LAFB need a long-term follow-up.