心脏瓣膜术后Ⅲ度房室传导阻滞的临床分析

Clinical analysis of degree Ⅲ atrioventricular block after cardiac valve surgery

目的 探讨心脏瓣膜术后Ⅲ度房室传导阻滞（Ⅲ°AVB）的发生原因、影响因素及相关治疗措施.方法 回顾性分析我院2000年1月至2008年12月3674例心脏瓣膜术后9例发生持续性Ⅲ°AVB并行永久性起搏器置入术患者的临床资料.心脏病因：风湿性心脏瓣膜病2例,感染性心内膜炎2例,主动脉瓣二叶畸形2例（其中合并感染性心内膜炎1例）,退行性主动脉瓣病变1例,先天性房室管畸形1例（既往有心脏手术史）,二尖瓣脱垂及非对称性肥厚性心肌病各1例.行主动脉瓣置换4例、二尖瓣置换2例、二尖瓣置换及三尖瓣成形1例、Bentall术1例、左室流出道疏通及二尖瓣置换1例.结果 本组9例患者,术后早期出现Ⅲ°AVB 7例,术后24～48 h出现Ⅲ°AVB 1例,术后4年出现Ⅲ°AVB 1例.出现Ⅲ°AVB持续时间超过2～3周不能恢复者,均行永久性起搏器置入术,其中采用DDD起搏器4例、VVI起搏器5例.无晚期死亡患者.结论 心脏瓣膜术后出现Ⅲ°AVB大多发生于术后早期,与手术部位有一定关系.术中注重心脏瓣膜结构与房室结及传导束的解剖关系,是预防术后出现Ⅲ°AVB的关键.Ⅲ°AVB持续时间超过2～3周者需行永久性起搏器置入术.

Objective To explore the reasons, oventrieular block after cardiac valve surgery. Methods influencing factors and treatments of the degree Ⅲ atri- Retrospeetive data of 9 patients with persistent degree Ⅱ atrioventricular block after cardiac valve surgery who received pacemaker implantation treatment between January 2000 and December 2008. Cardiac pathology including rheumatic valvular heart disease in 2 patients, degenerative aortic valvular disease in 1 patient, infective endocarditis in 2 patients, bicuspid aortic valve in 1 patient and with infective endocarditis in 1 patient, complete atrioventricular septal defect in 1 patient, others including mitral valve prolapse and hypertrophic obstructive cardiomyopathy in one patient. 4 patients had aortic valve replacement, 2 patients had mitral valve replacement, others including mitral valve replacement and tricuspid valve surgery, left ventricular outflow tract surgery and mitral valve replacement and Bentall in one patient. Results The onset of most postoperative degree Ⅲ atrioventrieular block was noted in the immediate postoperative period, 1 case happened after 4 years. The patients received pacemaker implantation treatment, if degree m AVB was present after cardiac valve surgery and persisted for 2-3 weeks. Of the 9 patients, 4 cases were treated with DDD pacemaker, others were VVI pacemaker. Condusion Valve surgery sites are the key factors to AVB after cardiac valve surgery. Mostly are noted in immediate postoperative period. Patients with degree Ⅲ AVB persist more than 2-3 weeks should be treated with permanent pacemaker implantation.