封堵器介入治疗室间隔缺损对术后传导阻滞发生的影响

Effect of occluders on occurrence of heart blocks after transcatheter device closure in patients with perimembranous ventricular septal defect

目的分析对称型和不对称型封堵器介入治疗膜周部室间隔缺损(PMVSD)术后传导阻滞的发生率及其影响因素。方法成功植入106例偏心型室间隔缺损封堵器(AVSDO)和122例对称型室间隔缺损封堵器(SVSDO)的PMVSD患者,于术前、术后1周、1、3、6个月及每年分别行常规ECG和Holter检查。结果术后新发生传导阻滞33例,AVSDO组与SVSDO组发生率无统计学差异(14.2%vs.14.8%)(P>0.05)。33例中以右束支传导阻滞(RBBB)最常见(19例),其次为左束支传导阻滞(LBBB)(8例)和房室传导阻滞(AVB)(6例);1例Ⅱ度Ⅱ型AVB和3例Ⅲ度AVB均经临时起搏、激素治疗后恢复为正常窦性心律;出院前21例传导阻滞消失。发生传导阻滞者较未发生者的PMVSD距主动脉瓣距离(DDRAV)长,PMVSD距三尖瓣隔瓣的距离(DDSTV)短,封堵器直径与PMVSD直径的差值(DDOV)大(P<0.05)。新发生传导阻滞出现时间越早越难恢复。结论应用AVSDO和SVSDO介入治疗PMVSD术后传导阻滞发生率相似,且多数能恢复正常。DDSTV、DDRAV和DDOV可作为术后新发传导阻滞较好的预测指标。

Objective To analyze the incidence and risk factors for occurrence of heart blocks（HBs） after transcatheter closure of perimembranous ventricular septal defect（PMVSD） with asymmetric occluders（AVSDO） and symmetric occluders（SVSDO）.Methods Transcatheter closure of PMVSD was carried out in 106 patients with AVSDO and 122 patients with SVSDO.Electrocardiography and 24-hour Holter monitoring were performed before,at one week,1,3,6 months and every year after operation.Results HBs occurred in 33 patients.There was no significant difference between AVSDO group and SVSDO group in the incidence of HBs（14.2% vs.14.8%）（P0.05）.The incidence of HBs was in an order of RBBB（19 cases）LBBB（8 cases）AVB（6 cases）.High degree atrioventricular blocks occurred in 4 patients and recovered to normal conduction after intravenous administration of hydrocortisone.HBs recovered to normal conduction in 21 patients before discharge.Compared to the patients without HBs,the patients with PPHBs were characterized by a significantly longer distance between the aortic valve and the defect（DDRAV）,a shorter distance from the lower rim of the defect to the septal leaflet of the tricuspid valve（DDSTV） and a larger diameter difference between the occluder and PMVSD（DDOV）（P0.05）.The earlier the HBs developed,the more the HBs difficultly recovered.Conclusion The incidence of HBs after transcatheter closure of PMVSD with AVSDO is similar to that with SVSDO.Most of HBs could recover to normal conduction.Measurements of DDSTV,DDRAV and DDOV might be useful to predict the occurrence of HBs.