儿童室间隔缺损封堵术后完全性右束支传导阻滞对心功能的影响

Influence of complete right bundle branch block on cardiac function in children after ventricular septal defect closure

目的评估儿童室间隔缺损(ventricular septal defect,VSD)封堵术后完全性右束支传导阻滞(complete right bundle branch block,CRBBB)对左心室和右心室功能的近期影响。方法按随机数字表法选取从2010年1月至2014年12月于中山市人民医院行VSD封堵术后出现CRBBB的40例患者作为CRBBB组以及40例封堵术后无心律失常的患者为对照组。所有患者均完善术前及术后心电图、超声心动图检查,规律随访超过1年。所有患者在最后一次随访时均完善心电图、常规超声心动图及组织多普勒成像(TDI)检查。结果 CRBBB组和对照组手术年龄比较,差异无统计学意义[(5.62±1.84)岁眠(5.80±1.65)岁,P>0.05]。最近一次随访中,常规超声心动图提示CRBBB组和对照组的左心室射血分数比较,差异无统计学意义(73.82%±8.55%诋75.46%±9.95%,P>0.05);两组短轴缩短率比较,差异无统计学意义(36.06%±2.95%眠37.02%±3.16%,P>0.05);两组右心室面积变化分数比较,差异有统计学意义(35.53%±5.33%vs.39.68%±3.51%,P<0.05)。组织多普勒成像提示CRBBB组和对照组仅在三尖瓣右心室侧壁附着点舒张早期心肌速度[(1.80±0.20)m/s眠(1.91±0.25)m/s,P<0.05]和三尖瓣右心室侧壁附着点舒张晚期心肌速度[(1.62±0.22)m/s vs.(1.71±0.19)m/s,P<0.05]比较,差异有统计学意义;而两组其他测量参数比较,差异无统计学意义(P>0.05)。结论儿童VSD封堵术后CRBBB可对右心室功能产生一定程度影响,这种影响尚不足以引起心功能不全及相关临床症状,但其对右心功能的影响是否可随时间进一步加重,尚需要进一步研究。

Objectives To evaluate the influence of complete fight bundle branch block （CRBBB） on left ventricular and right ventricular function in children after transcatheter closure of ventricular septal defect （VSD）. Methods Totally 40 patients with postoperative CRBBB from January 2010 to December 2014 in Zhongshan City People＇s Hospital were randomly selected as CRBBB group, while another 40 cases without CRBBB after VSD closure were selected as control group. All the patients underwent preoperative and postoperative electrocardiogram and echocardiogram examination, and had been followed up for more than one year. All the patients were checked with electrocardiogram, echocardiography and tissue Doppler imaging （TDI） examination at the last follow-up. Results Average age at surgery （years） between CRBBB group and control group had no significant difference [ （5.62±1.84） years vs. （5.80±1.65） years, P〉0.05 ]. At the latest follow-up, conventional echocardiography indicated that left ventricular ejection fraction （73.82%±8.55% vs. 75.46%±9.95%, P〉0.05） and fractional shortening （36.06%±2.95% vs. 37.02%±3.16%, P〉 0.05 ） between CRBBB group and control group were statistically similar. Right ventricular fractional area change （RV- FAC） between the two group had significant difference （35.53%±5.33% vs. 39.68%±3.51%,P〈0.05）. TDI examination indicated that there were no significant differences in the measurement parameters between CRBBB group and control group except for early diastolic myocardial velocity （Em） [ （1.80±0.20） m/s vs. （1.91±0.25） m/s, P〈0.05 ] and late diastolic myocardial velocity （Am） [ （ 1.62±0.22） m/s vs. （ 1.71 ±0.19 ） m/s, P〈0.05 ] of the tricuspid valve. Theother measurement parameters had no significant differences between CRBBB group and control group. Conclusions CRBBB in children after VSD occluder closure can affect the right ventricular function in this study. This effect is not enough to cause cardiac dysfunction and relative clinical symptoms, but it is worthy for further study to insure its impact on the right ventricular function in long-term follow-up.