先心病手术后植入永久起搏器治疗房室传导阻滞

Permanent pacemakers implantation for atrioventricular block after surgical repair of congenital heart disease

目的探讨先天性心脏病手术后安装永久性起搏器对术后心脏房室传导阻滞的临床疗效。方法2007年8月到2013年6月我们对7例患儿经心脏表面电极植入永久起搏器，其中男3例，女4例，平均年龄（19．29±28．93）个月，平均体重（7．91±4．05）kg，完全房室通道缺损3例，术后均为Ⅲ度房室传导阻滞，3例室间隔缺损修补术后，其中1例为Ⅱ度二型房室传导阻滞，2例为Ⅲ度房室传导阻滞，法乐氏四联症根治术后1例，术后为Ⅲ度房室传导阻滞。术后静脉或口服激素治疗1个月，心律无恢复，6例侧开胸安装单腔起搏器，1例正中开胸安装房室顺序起搏器。结果术后死亡1例，1例切口破溃。1例术后起搏电极导线断裂，但已恢复正常心律。结论激素电极心脏表面永久起搏器是应对小儿先天性心脏病术后房室传导阻滞的安全和有效手段，可以维持患儿生存和正常生长发育的需要。

Objetive AtrioventrieuIar conduction block is one of complications after the surgical repair of congenital heart disease. If atrioventricular block did not recovered it would need implantation of the permanent pacemaker. There are two ways include transvenous and epicardial lead implantation. Methods Seven cases were implanted permanent pacemaker from Aug,2007 to Jun,2013 ,three of them were boys ,and four eases were gifts. The average age was （ 19.29 ± 28.93） months, average weight was （ 7.91 ±4.05 ） kg. Three cases of them were completed atrioventriculaer defects, three eases were ventrieular defects, and one case was tetralogy of Fallot. Six of the seven were completed atrioventricular block, except one case of ventricular defect was second atrioventicular block. Results After whole month of hormonal therapy, none of them were eardioversion. The six cases of them implanted one chamber pacemaker through lateral incision of thorax with epicardial lead and one of them implanted two chamber pacemaker through median incision. One case of .multiple .ventricular defects died and one case had skin broken. One case had fracture of lead line but cardiac rhythm had recovered. Conclusion Steroid-Eluting epieardial Pacing Leads pacemaker was the best way to cope with the children with complete atrioventricular block,it can help maintain the survival and the growth of the children.