经导管封堵膜周部室间隔缺损术后早期房室传导阻滞发生的危险因素

Risk factors of early atrioventricular block after transcatheter closure of perimembranous ventricular septal defect

目的探讨膜周部室间隔缺损(室缺)经导管封堵术后早期房室传导阻滞发生率及其危险因素。方法 100例膜周部室缺患儿,隔瓣下室缺30例、膜部室缺21例、偏流出道室缺29例、嵴内室缺20例,其中伴有成熟膜部瘤27例。患儿均采用经皮介入封堵术,术后行经胸超声心动图检查,观察术后早期房室传导阻滞发生率及影响因素。结果本组介入治疗成功率97%(97/100),3例介入治疗失败,其中2例因主动脉瓣右冠瓣脱垂伴主动脉瓣中-重度反流而停止介入手术,1例封堵器移位外科手术取出;7例术后12h内发生不同类型房室传导阻滞,发生率为7.2%(7/97);体质量<10kg及动-静脉轨道建立时间>1h和膜周部室缺类型与房室传导阻滞发生相关。结论严格手术适应证,缩短手术操作时间,有助于降低膜周部室缺介入封堵术后房室传导阻滞发生率。

Objective To explore the incidence of early atrioventricular block after transcatheter closure of perimembranous ventricular septal defect （VSD） and its risk factors. Methods The clinical data of 100 patients with perimembranous VSD were retrospectively analyzed, including septal leaflet of VSD in 30 patients, membranous VSD in 21, drift debut of VSD in 29, and crest chamber septal defect in 20, in which 27 were complicated by mature membranous aneurysm. All patients were treated by percutaneous transcatheter closure, and the early atrioventricular block and its risk factors were observed after the operation by electrocardiography and transthoracic ecbocardiography. Results The total success rate of interventional occlusion was 97% （97%）. Three failed （3/100）, in which interventional occlusion stopped due to proplapse of the right coronary cusp of the aortic valve complicated by moderate to severe requrqition in 2, and 1 patient turned to surgical operation because of occluder displacement. Different types of atrioventricular block occurred in 7 （7.2%） after operation in 12 hours. Body mass 〈 10 kg, arteriovenous track building time 〉1 h, and perimembranous VSD types were closely correlated with atrioventricular block. Conclusion To select the indications strictly and shorten the operation time can reduce the incidence of atrioventricular block after transcatheter closure.