室间隔缺损封堵术对心电及心室重构的影响

Clinical significance of electrocardiography and ventricular changes of congenital heart disease after surgery

目的:探讨室间隔缺损(VSD)封堵术对心电及心室重构的影响。方法:成功施行经皮导管封堵术的VSD患儿108例,观察VSD患儿封堵术前后心电参数和心室形态。结果:与VSD封堵术前比较,术后3d的束支传导阻滞发生率明显增多,但术后3个月及6个月的束支传导阻滞发生率又逐渐减少;术后束支传导阻滞发生率与VSD大小呈正相关;VSD封堵术后2d内阵发性室性心动过速发生率明显多于术前。与VSD封堵术前比较,术后3个月及6个月的左室舒张末期内径、左室收缩末期内径及左室舒张末期容积、左室收缩末期容积明显减小;术后3个月右室舒张末期内径明显缩小;与术前比较,从术后1个月开始左室每搏量明显减小,而手术前后左室射血分数无明显变化。结论:经导管VSD封堵术后,部分患者出现新的心电改变,表现在术后2d内阵发性室性心动过速发生率增多,3d内束支传导阻滞发生率增多,但术后3个月后束支传导阻滞发生率下降。VSD封堵术后心室形态及功能有不同程度恢复。

Objective：To investigate the influence on cardiogram and ventricular remodeling after cardiac closure procedure for children with ventricular septal defeet （VSD）. Method： There are 108 cases of children with VSD, which were operated by percutaneous catheter occlusion triumphantly, observed in VSD patients with transcatheter occlusion electrocardiography （ECG） parameters and ventricular morphology before and after procedure. Result：Compared with the VSD closure compared with preoperative, postoperative 3-day RBBB/LBBB were significantly increased, but RBBB/LBBB rate gradually decreased to normal after 3 months and 6 months. VSD closure after 2 days in patients with paroxysmal ventricular tachycardia were significantly more than before. LVED, LVSD and LVEDV and LVESV significantly reduced after 3 months and 6 months. RVED significantly reduced after 3 months. Compared with the pre-operative, after a month LVSV was significantly reduced, and LVEF was no significant change before and after surgery. Conclusion： VSD after transcatheter closure, some patients had the emergence of new ECG changes, In after 2 days of paroxysmal ventricular tachycardia rate increasing, bundle branch block rate increasing in 3 days, but after 3 months after the bundle branch block the incidence declining. After VSD closure ventricular structure and function have different levels to resume.