B型心室预激对室壁运动及左心室功能的不良影响分析

Adverse effects of type B ventricular pre-excitation on ventricular wall motion and left ventricular function： clinical analysis of 9 cases

目的 分析B型心室预激对室壁运动及左心室功能的不良影响及其特点.方法 对2011年3月至2013年3月北京安贞医院小儿心脏中心收治的9例因B型心室预激对室壁运动及左心室功能发生不良影响的患儿射频消融前后的临床、超声及电生理特点进行分析.患儿年龄3 ～16岁,女5例,男4例.结果 9例患儿心脏M型超声均显示室间隔与左心室后壁呈不协调运动,其中6例患儿二维超声检查发现室间隔基底段变薄且呈瘤样矛盾运动.9例患儿中2例旁路位于右前间隔,7例位于右侧游离壁.4例合并扩张型心肌病者经射频消融后体格发育及体力活动量明显改善;发作间期有胸闷及疲乏不适的患儿症状消失.9例患儿消融后心脏超声提示左心室收缩协调,左心功能逐渐恢复正常,左心室舒张末期内径明显回缩至正常或接近正常.结论 B型心室预激中的右侧前间隔或游离壁显性旁路可致室壁运动异常、左心室收缩功能下降及左心室扩大,严重者可致扩张型心肌病.左心室收缩不同步可能是其最重要的发病机制.此类患儿为射频消融良好指征,预后良好.

Objective To analyze the adverse effects of type B ventricular pre-excitation on ventricular wall motion and left ventricular function and its clinical characteristic.Method The clinical,electrophysiological and echocardiographic characteristics of the 9 cases with type B ventricular pre-excitation before and after ablation seen between March 2011 and March 2013 were analyzed.The patients aged from 3 to 16 years.Five of them were female.Result Dyschronous left ventricular contraction was demonstrated by M-Mode echocardiography in all of the cases.The basal segments of the interventricular septum turned thin and moved in a manner similar to that of an aneurysm,with typical bulging during end-systole,which was observed in six cases.All patients received successful RFCAs.The locations of the accessory pathways （APs） were the right-sided anteroseptum （n =2） and the free wall （n =7）.Their physical activities and growth improved greatly in the four cases with coexisting dilated cardiomyopathy （DCM）.The echocardiographic data demonstrated that their LV contraction recovered to synchrony shortly after the ablation,LVEF recovered to normal and LVED decreased to almost normal gradually during the follow-up.Conclusion Overt right-sided APs may have adverse effects on ventricular wall motion and left ventricular function.They can even result in DCM.Dyssynchronous ventricular contraction induced by right-sided overt accessory pathway may be the vital mechanism.Such kinds of cases are indication for ablation with good prognosis.